This position is located in the Purchased Referred Care Department at Northern Cheyenne Service Unit, Lame Deer, MT. The purpose of the position is to administer the provision of Purchased Referred care in compliance with regulatory requirements. Duty Location will be located in Lame Deer, MT, with telework eligible as determined by the agency policy.

Duties

Verifies and determines patient's eligibility for Medicare, Medicaid, Private Insurance, VA or other potential alternate resources Performs prescreening process for potential eligibility and gathers pertinent information utilized to determine PRC eligibility and potentially eligibility for alternative resources Conducts in-depth face-to-face interview or by telephone with patients and/or families to ensure accurate information is included in patient referrals for continuity of care and payment coordination Initiates medical authorizations and denial of service for inpatient/outpatient/ancillary medical services for eligible IHS beneficiaries Maintains complete fund control records for health services funds allotted

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-06: One (1) year of specialized experience equivalent to the GS-05 grade level. GS-07: One (1) year of specialized experience equivalent to the GS-06 grade level. GS-08: One (1) year of specialized experience equivalent to the GS-07 grade level. Specialized Experience Experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform successfully the duties of the position, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level. Applicants who have the 1 year of appropriate specialized experience are not required by this standard to have general experience, education above the high school level, or any additional specialized experience to meet the minimum qualification requirements. 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: Examples of Specialized Experience: GS-06: Retrieve, organize, and prepare medical records, perform routine clerical duties, assist individuals in completing forms, conduct in-person or telephone interviews, verify patient eligibility for benefits; explain and interpret regulations and policies. GS-07: Knowledge of policy and regulations related to medical records confidentiality, analyze and code medical records in automated record systems, review claims, conduct in-person or telephone interviews, verify patient eligibility for benefits, assist individuals in completing forms, interpret and explain rules and regulations for a variety of alternate resources. GS-08: Provide information or rights and benefits of multiple alternate resources and advise patients of nonpayment or claim approval; monitor pending actions, interpret and explain rules and regulations for a variety of alternate resources, compile and write reports, research records, or guidelines, verifies and determines patient's eligibility, initiates payment for referred services and documents all patient transactions according to regulation. In describing your experience, please be clear and specific. We do not make assumptions regarding your experience. Your resume must support your application responses. 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 Northern Cheyenne Service Unit PO Box 70 100 Cheyenne Ave Lame Deer, MT 59043 US
• Name: Tamra O'Neill
• Phone: (406)850-4903
• Email: tamra.o'[email protected]