This position is located in the Purchased Referred Care Department at an IHS Service Unit. The purpose of the position is to administer the provision of Purchase/Referred Care (PRC) in compliance with regulatory requirements to determine patient's eligibility for third party resources.

Duties

Receives, enters, and edits all non-IHS and IHS referrals. Verifies and determines patient's eligibility for third party resources. Performs research related to medical documentation, administrative compliance, and inquiries. Conducts in-depth face to face interviews or by telephone to gather pertinent information related to patient care. Ensures PRC funds are available prior to issuance of obligating documents on behalf of the government. Initiates medical authorizations. Gathers all necessary information for appeals or denials. Prepares periodic and special reports. THIS POSITION IS BEING ANNOUNCED CONCURRENTLY WITH ANNOUNCEMENT #12600918 FOR CANDIDATES AT THE GS-08 LEVEL. APPLICANTS MUST APPLY SEPARATELY FOR EACH ANNOUNCEMENT TO BE CONSIDERED.

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: Work experience that demonstrates comprehensive knowledge of rights and benefits of multiple alternate resources; advise patients of nonpayment or approval of claim; compile and write reports; contact alternate resources to explore reasons for adverse decision, the possibility of reconsideration, whether there are grounds for appeal; complete contacts independently including review of complex records, reconstruction of involved transactions, analysis of precedent decisions. 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 Mashpee 483 Great Neck Road South Mashpee, MA 02649 US
• Name: Pamela Harrison
• Phone: 615-584-7964
• Email: [email protected]