This position serves as the Contract Representative in the Purchased Referred Care department of the Clinton Indian Health Center in Clinton, Oklahoma. This position is responsible for customer service, eligibility verification, coordination of care, and the patient referral process. This position reports to the Purchased Referred Care Supervisor of the Clinton Service Unit.

Duties

Verifies patient's eligibility for Purchased/Referred Care by reviewing documentation regarding eligibility and alternate resources. Receives referrals from physicians and emergency call-ins for Purchased Referred Care; evaluates each case according to current priorities and availability of funds. Assist in preparation, submission, and payment of processes of purchase orders for services rendered.

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: Applicant(s) must meet one of the following minimum requirements to meet the GS-06 level: 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: Provide clerical duties such as making appointments, data entry, maintaining files, and answering phone calls; Conduct interviews in order to determine patient's eligibility for services; Issue medical referrals and denial letters for medical services; Communicate with patients regarding medical bills, claim status, and referrals. Applicant(s) must meet one of the following minimum requirements to meet the GS-07 level: 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: Assess and educate patients in regard to unique health services and program eligibility; Initiate medical authorizations and denial of service for medical services; Prepare and distribute purchase order authorizations for patient care services and ensure prompt payment; Research vendor claims and purchase orders to provide prompt follow-up; Review incoming claims from providers to determine if authorizations are approved or denied. Applicant(s) must meet one of the following minimum requirements to meet the GS-08 level: 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: Prepare and distribute purchase order authorizations for patient care services and ensure prompt payment; Conduct comprehensive patient interviews to determine eligibility for alternate health insurance resources; Provide recommendations to patients on the various health care benefit programs and eligibility criteria based on current health care laws and regulation; Conduct extensive research and providing benefit updates involving changes in rules and regulations for alternate resources; Review financial reports for reconciliation with outstanding accounts and progressive payments to ensure accuracy. You must meet all qualification requirements within 30 days of the closing date of the announcement.

Education

This position has no education requirement.

Contacts

• Address Clinton Service Unit Rt 1 Box 3060 Clinton, OK 73601 US
• Name: Starr Chavez
• Phone: 405-886-2540
• Email: [email protected]