About the Position: This position is located at Walter Reed National Military Medical Center, Director for Resource Management, Dept of Accounting Services Uniform Business Office. This is a Direct Hire Authority (DHA) solicitation utilizing the DHA for Certain Personnel of the DoD to recruit and appoint qualified candidates to positions in the competitive service.

Duties

Collaborate with health insurers to provide information such as, patient status, reimbursement of funds, review and explanation of authorizations. Communicate with Uniform Business office staff to assist in interpreting clinical information to over denials. Communicate with insurance companies, patients and other interested parties regarding approvals/denials and appeals. Review daily admission reports and provide pre-certification information as required. Provide case specific clinical documentation to insurance providers for initial and/or continued stay. Perform concurrent utilization review and communicate with insurance carrier on continued stay. Schedule peer to peer request between healthcare providers. Complete authorization of retroactive third-party insurance claims. Correspond in writing, and via phone, with insurance companies, patients, and other interested parties regarding approval/denial of bills.

Requirements

• This position requires the incumbent be able to obtain and maintain a determination of eligibility for a Secret security clearance or access for the duration of employment. A background investigation and credit check are required.
• This position requires that you obtain and maintain a Basic Life Support (BLS) certification from, or in accordance with, the American Heart Association and American Red Cross. Advanced certification (e.g., ALS) does not supersede BLS.
• All applicants tentatively selected for this position will be required to submit a urinalysis to screen for illegal drug use prior to appointment.
• This position is subject to a pre-employment screening, and random drug testing, to include testing based on reasonable suspicion and testing due to direct involvement with an on-duty accident.
• Immunization screening is required. Hepatitis B immunization is required for all positions with direct patient contact. Applicants may be required to show proof of other immunizations depending on the type of position.
• This position has mandatory seasonal Influenza vaccination requirements and is subject to annual seasonal Influenza vaccinations unless otherwise exempted for medical or religious reasons (documentation of exemption must be provided upon hire).
• This position requires the incumbent to have Tuberculosis testing.
• Applicants must be able to fulfill non-privileged professional credential requirements.
• This position has been designated Mission Essential. In the event of severe weather conditions or other such emergency type situations, the incumbent is required to report to work or remain at work as scheduled to support mission operations.
• This position may require the incumbent to work on call during irregular work hours which may include evenings, weekends, holidays, and/or varying work schedules.
• This position may require the incumbent to work on call during irregular work hours which may include evenings, weekends, holidays, and/or varying work schedules.
• You may be authorized to Telework on a Situational basis.

Qualifications

Who May Apply: US Citizens In order to qualify, you must meet the education and experience requirements described below. 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; student; social). You will receive credit for all qualifying experience, including volunteer experience. Your resume must clearly describe your relevant experience; if qualifying based on education, your transcripts will be required as part of your application. Additional information about transcripts is in this document. Basic Requirement for Nurse (Consultant/Third-Party Collections): Degree: A graduate or higher level degree, bachelor's degree, associate degree, or diploma from an accredited professional nursing educational program is required. This education must have been accredited by the Commission on Collegiate Nursing Education, Council on Accreditation of Nurse Anesthesia Educational Programs, Accreditation Commission for Midwifery Education, or an accrediting body recognized by the U.S. Department of Education at the time the degree was obtained. (Note: You must attach a copy of your transcripts.). Licensure: A current, active, full, and unrestricted license or registration as a professional nurse from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States; and you must have passed the National Council Licensure Examination. Foreign Degree: Graduates of foreign nursing schools must have completed the Commission on Graduates of Foreign Nursing Schools Certification Program. The certification program consists of a credentials evaluation, the CGFNS Qualifying Exam, and evidence of passing one of the approved English Language Proficiency examinations. A copy of the CGFNS Certificate is required. Exemption: You are exempt from the basic requirements above if you are a current federal employee occupying a position in the 0610 occupational series and have been continuously employed in this occupational series since September 27, 2017 or before. Note: You will be required to provide appropriate documentation to the respective Human Resources Office to validate your status. In addition to meeting the basic requirement above, to qualify for this position you must also meet the qualification requirements listed below: Education/Experience: A diploma, associate degree, or bachelor's degree in Nursing from a professional nursing program and possession of at least one full year of professional nursing experience (equivalent to the GS-9 grade level or above) which includes coordinating authorization for treatment under the respective insurance coverage; providing documentation to insurance companies to coordinate care and/or medical treatment; advising hospital staff on guidelines and/or criteria for patient care by third party payers.. OR Education: A PhD or equivalent doctoral degree from a professional nursing educational program or related medical science field. Exemption: You are exempt from the qualification requirements above if you are a current federal employee occupying a position in the 0610 occupational series and have been continuously employed in this occupational series since September 27, 2017 or before. Note: You will be required to provide appropriate documentation to the respective Human Resources Office to validate your status.

Education

See education requirements described in qualification section.

Contacts

• Address JT-DHA-DDAAFF DHA NCR MKT-WR NATL MIL MED CTR DO NOT MAIL Bethesda, MD 20889 US
• Name: Army Applicant Help Desk