This position is located in the Purchased/Referred Care at an IHS Service Unit. The purpose of the position is to administer the provision of Purchased/Referred Care to determine patient's eligibility, defining and interpreting PRC regulations and guidelines and maintaining records. Employee identifies and assists patients who may be eligible for coverage by third party resources. Subject matter expert in determining patient's PRC eligibility and advise others as needed.

Duties

Receives notification and referrals for non-IHS and IHS referred care through hard copy or the automated referred care system. Enters or edits all referrals. Ensures accurate data entry in order to retrieve meaningful reports. Verifies and determines patient's eligibility for Medicare, Medicaid, Private Insurance, VA or other potential alternate resources as appropriate, which are available and accessible to the individual. Develops and implements procedural guides; compiles and interprets various alternate resource references and guides. Ensures that PRC funds are available prior to issuance of obligating documents on behalf of the government. Provides forecasting of weekly document control register balances after each week's obligations have been completed to ensure funds are expended in accordance within spending plans. Maintains complete fund control records for health services funds allotted. Ensures the presence of accurate information, monitors activities and records pertaining to the fiscal management of funds. Identifies problem areas and recommends corrective action. Reconciles the commitment register to the automated financial system. Issues correspondence to patients, health care providers and other agencies regarding eligibility, IHS policy and regulations, including letters of denial of payment where the requirements of the IHS Program are not met. Maintains program files including letters of denials with all backup material for reason for denial, elective procedures, etc. Completes timely response to Service Unit Appeals through review of case files and all supporting information. Maintains appeal record files in keeping with the appeal process contained in federal regulations or policies. Tracks all referrals to non-IHS facilities to include those referrals to other IHS facilities to support the Case Management activities and continuity of care efforts. Participates in the weekly Case Management meetings, takes minutes and prepares the minutes for record and reporting purpose. Researches and follow up with non-IHS facilities on weekly basis for current medical status and costs to determine whether the case will be a Catastrophic Health Emergency Fund (CHEF) case.

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: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: GS-06: One (1) year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-05 level in the Federal service as described in the vacancy announcement. Examples include implementing screening and interview methods to obtain or verify information; assisting patients or customers with completing forms and interpretation of rules and regulations; and coordinating work with other organizations or parts of the organization. GS-07: One (1) year of specialized experience that equipped me with the particular knowledge, skills andabilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-06 level in the Federal service as described in the vacancy announcement. Examples include interpreting and applying private sector and government program regulations to assure procedures are properly applied for alternate resources programs such as Medicare and Medicaid; conducting in-depth patient interviews to determine eligibility for alternate health insurance resources; registering eligible patients in various programs; researching alternate resources; and prioritizing workload to complete multiple tasks within specified time frames. GS-08: One (1) year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-07 level in the Federal service as described in the vacancy announcement. Examples include interpreting and applying private sector and government program regulations to assure procedures are properly applied for alternate resources programs such as Medicare and Medicaid, Affordable Care Act, VA Healthcare, Pharmacy Assistance Programs, etc; conducting in-depth patient interviews to determine eligibility for alternate health insurance resources; registering eligible patients in various programs; prioritizing workload to complete multiple tasks within specified time frames; providing recommendations to patients on the various health care benefit programs and eligibility criteria based on current health care laws and regulations; conducting extensive research and providing benefit updates involving changes in rules and regulations for alternate resources; compiling data and writing reports; and assisting in settling controversial benefit issues. 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

There are no education requirements.

Contacts

• Address Claremore Service Unit 101 S Moore Claremore, OK 74017 US
• Name: Raquel Sells
• Phone: 918-282-6049
• Email: [email protected]