This position is within the Patient Business Services in the Phoenix Indian Medical Center located in Phoenix, AZ. Incumbent is responsible for generating third party alternate resources claims and tracking insurance claims and payments. Responsible for the examination, verification and maintenance of data involved in processing alternate resources reimbursement and performing other related support duties in the Third Party Reimbursement Program.

Duties

The position requires skill in independent analysis and problem solving to develop appropriate information and evidence in a timely manner using documentation to reach clear conclusions for proper reimbursement. Responsible for claim upon receiving, until claim has been paid by Third Party Payor. Receives and examines alternate resources claims to assure claims are complete with appropriate supporting documents which typically include utilization review certifications. Abstracts all necessary information by auditing the appropriate E & M and assigning the correct Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code. Independent analysis and problem solving to develop appropriate information and evidence in a timely manner using documentation to reach clear conclusions for proper reimbursement. Prepares and submits claims to third party payers, intermediaries or responsible parties within 48 hours after all information for billing becomes available.

Requirements

Qualifications

To qualify for this position, your resume must state sufficient experience and/or education, to perform the duties of the specific position for which you are applying. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; social). You will receive credit for all qualifying experience, including volunteer and part time experience. You must clearly identify the duties and responsibilities in each position held and the total number of hours per week. MINIMUM QUALIFICATIONS,GS-0679-07: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-06 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Examples include: Performing technical and specialized functions for an outpatient and inpatient medical record; performing quality assurance of medical records; and coding diagnostic and procedural information; responsible for claim upon receiving, until claim has been paid by Third Party Payer; responsibility of denials and appeals. Receives and examines alternate resources claims to assure claims are complete with appropriate supporting documents which typically include utilization review certifications; verify accuracy of health claim numbers, that claimed amounts are authorized, and that items of services billed are allowed by appropriate regulations, decisions, directives and other controlling guides. MINIMUM QUALIFICATIONS,GS-0679-08: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-07 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Examples include: Knowledge in a variety of billing, collections, accounting and budget functional areas and their relationships to other functions to research or investigate problems or errors that require reconciling and reconstructing incomplete information, conducting extensive exhaustive searches for required information, or performing actions of similar complexity. Knowledge of the various titles of the Medicare and Medicaid federal regulations, other public laws and regulations that apply to or affect the operation of billing of Third Party resource programs, and the policies and procedures described in operating instructions for these programs. **IHS Billing and/or coding experience is preferred but not required.** TYPING PROFICIENCY REQUIREMENT: In addition to meeting experience or education requirements, applicants must provide evidence of their typing proficiency of 40 words per minute typing speed based on a 5-minute sample from a school or other organization authorized to issue such certificates. Certificates must not be over three (3) years old. This agency accepts self-certifications. Time In Grade Federal employees in the competitive service are also subject to the Time-In-Grade Requirements: Merit Promotion (status) candidates must have completed one year of service at the next lower grade level. Time-In-Grade provisions do not apply under the Excepted Service Examining Plan (ESEP). You must meet all qualification requirements within 30 days of the closing date of the announcement.

Education

This position has an education requirement. You are strongly encouraged to submit a copy of your transcripts or a list of your courses including titles, credit hours completed, and grades. Unofficial transcripts will be accepted in the application package. Official transcripts will be required from all selectees prior to receiving an official offer.

Only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education may be credited. Applicants can verify accreditation at the following website: https://www.ed.gov/accreditation.

If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

Contacts

• Address Phoenix Service Unit 1616 E Indian School Rd Suite 360 Phoenix, AZ 85016 US
• Name: Phoenix Area IHS Human Resources
• Email: [email protected]