The purpose of the position is to administer the provision of Purchased/Referred Care in compliance with regulatory requirements set forth in the 42 CFR, Subpart 136, 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

Issue denial letters on a daily basis. Issue Purchase Orders on a daily basis. Schedule patient referral appointments. Prepare ER Notifications for submission to PRC Committee.

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: Minimum Qualifications, GS-0962-06 One (1) year of specialized experience equivalent to at least a GS-5 grade level. Examples of experience include: implementing screening and interview methods to obtain or verify information; and assisting patients or customers with completing forms and interpretation of rules and regulations and coordinating work with other organizations or parts of the organization. Minimum Qualifications, GS-0962-07 One (1) year of specialized experience equivalent to at least a GS-6 grade level. Examples of experience include: interprets and applies private sector and government program regulations to assure procedures are properly applied for programs such as, Purchase Referred Care, Medicare and Medicaid; conducting in-depth patient interviews to determine eligibility for alternate health insurance resources; registering eligible patients in various programs; resolving a wide range of problems and make appropriate decisions; and prioritizing workload to complete multiple tasks within specified time frames Minimum Qualification, GS-0962-08 One (1) year of specialized experience equivalent to at least a GS-7 grade level. Examples of experience include: interprets and applies private sector and government program regulations to assure procedures are properly applied for programs such as, Purchase Referred Care, Medicare and Medicaid, Affordable Care Act, Veterans Affairs Healthcare, Pharmacy Assistance Programs, etc.; conducting in-depth patient interviews to determine eligibility for alternate health insurance resources; registering eligible patients in various programs; effective oral and written communication; resolving a wide range of problems and make appropriate decisions; compiling data and writing reports; and assisting in settling controversial benefit issues; and prioritizing workload to complete multiple tasks within specified time frames. 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.

This position is being announced concurrently under the Delegated Examining procedures. Please review vacancy announcement number IHS-25-GP-12605414-DE; for eligibility requirements. NOTE: Applicants must apply separately for each announcement in order to be considered.

Contacts

• Address Sisseton Service Unit PO Box 189 100 Lake Traverse Drive Sisseton, SD 57262 US
• Name: Joseph Dudley
• Phone: 605-252-2771
• Email: [email protected]