This position is located in the Business Office Branch At the Gallup Indian Medical Center in Gallup, NM. The primary purpose of this position is to function as the Health Benefits Coordinator, identifying patients with eligibility for alternate resources, assisting them with the enrollment process, serving as advocate for Indian patients in the effective utilization of alternate resources, and act as liaison between the Business Office Branch and non-lHS providers and facilities.

Duties

Provides leadership and serves as an advocate for Indian patients in the effective utilization of alternate resources and the eligibility process for Medicare, Medicaid, Department of Veterans Affairs, Social Security Administration, Bureau of Employment Compensation, Third Party Liability, Worker's Compensation, Children's Special Health Services, and Temporary Aid to Needy Families (TANF), etc. Provides information on rights and benefits of multiple alternate resources, and tactfully advises patient of non-payment or denial of claims. Identifies and follows up on pending applications, working closely with families and agencies involved on the concept that the patient is not discriminated against because they are IHS recipients. Ensures timely entry of all Private Insurance, Medicaid (New Mexico and AHCCCS), and Medicare information to augment outpatient and inpatient billing efforts. Works closely and assists the patient, their families, and all other parties involved in initiating and completing the Medicare and Medicaid applications. Interprets rules and regulations on usage of the eligibility coverage. Works closely with Social Services, Purchased/Referred (PRC), Utilization Review Program, the local County Department of Welfare, Department of Human Resources, Tribal Offices, and with other appropriate agencies, to establish eligibility or provide accurate referrals in establishing eligibility for Medicare, Medicaid, SOBRA, SNAP (Food Stamps), Social Security Disability, and Supplemental Security Income (SSI).

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-05: Applicant must have successfully completed 4 years above high school leading to a bachelors degree -OR- 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: Assist individuals in completing forms, provide information to the public, conduct personal or telephone interviews by utilizing screening and interviewing methods, verify patient eligibility for benefits, review claims and review records; establish and maintain contact with internal/external entities, local and regional agencies, programs and offices in order to obtain relevant information. Combining Education and Experience: Equivalent combinations of successfully completed post-high school education and experience may be used to meet total experience requirements at grades GS-5 and below. For GS-5 level positions, only education in excess of the first 60 semester hours (i.e., beyond the second year) is creditable toward meeting the specialized experience requirement. One full academic year of study (30 semester hours) beyond the second year is equivalent to 6 months of specialized experience. GS-06: 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: Assist individuals in completing forms, provide information to the public, conduct personal or telephone interviews by utilizing screening and interviewing methods, verify patient eligibility for benefits, review claims and review records; establish and maintain contact with internal/external entities, local and regional agencies, programs and offices in order to obtain relevant information; monitor pending actions. GS-07: 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: Assist individuals in completing forms, provide information to the public, conduct personal or telephone interviews by utilizing screening and interviewing methods, verify patient eligibility for benefits, review claims, review records, establish and maintain contact with internal/external entities, local and regional agencies, programs and offices in order to obtain relevant information; monitor pending actions, interpret and explain rules and regulations for a variety of alternate resources. GS-08: 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: Assist individuals in completing forms, provide information to the public, conduct personal or telephone interviews by utilizing screening and interviewing methods, verify patient eligibility for benefits, review claims, review records, establish and maintain contact with internal/external entities, local and regional agencies, programs and offices in order to obtain relevant information. monitor pending actions, interpret and explain rules and regulations for a variety of alternate resources, compile and write reports, research records or guidelines; advise individuals on all aspects of benefits. 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

This position has an education requirement. You are strongly encouraged to submit a copy of your transcripts or a list of your courses including titles, credit hours completed, and grades. Unofficial transcripts will be accepted in the application package. Official transcripts will be required from all selectees prior to receiving an official offer.

Only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education may be credited. Applicants can verify accreditation at the following website: https://www.ed.gov/accreditation.

If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

Contacts

• Address Gallup Service Unit 516 E Nizhoni Blvd P O Box 1337 Gallup, NM 87301 US
• Name: Navajo Area IHS Human Resources
• Email: [email protected]