This position is located in patient business services, third-party billing program, accounts receivable and claims denial and appeal section. The incumbent is responsible for generating third-party alternate resources claims and tracking insurance claims and payments. The incumbent is 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 billing program.

Duties

Responsible for claim upon receiving, until claim has been paid by third party payor. This includes responsibility of denials and appeals. Abstracts all necessary information by auditing the appropriate E & M and assigning the correct Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding Systems (HCPCS) code, which most accurately describes each medically documented procedure according to established guidelines and practices for outpatient visits. Determines that receipts are properly processed and that the total agrees with the pre-determined control totals. Reviews reports and listings to assure that they are in balance, proper format, sequenced and that accounting data is valid. Provides technical assistance with processing and maintaining CPT coding, abstraction of the complete chart (outpatient) and compliance enforcement of all regulator requirements.

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: 0679-07 Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level (GS-06) in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: knowledge of the Resource Patient Management System (RPMS), Knowledge of Freedom of Information Act, ICD Coding, Billing, Collections, Accounting, Medical Claims, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS). MINIMUM QUALIFICATIONS: 0679-8 Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level (GS-07) in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: performing independent analysis and problem solving to develop appropriate information and evidence timely to generating third party alternate resources claims; tracking insurance claims and payments in all levels of examination; and maintenance of data in processing alternate resources reimbursement. 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 Phoenix Service Unit 1616 E Indian School Rd Suite 360 Phoenix, AZ 85016 US
• Name: Phoenix Area IHS Human Resources
• Email: [email protected]