Contact Representative

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).

Salary

• $39,993 - $71,321/year

Conditions of Employment

Selectee may be subject to a probationary/trial period
ESEP appointees typically serve a two year trial period
U.S. Citizenship is required
Selective Service Registration is required for males born after 12/31/1959

This is a designated position covered by Public Law 101-630, requiring contact or control over Indian children. Due to this requirement, the agency must ensure that persons hired for these positions have not been found guilty of or pleaded nolo contendere or guilty to certain crimes.

Confidential Financial Disclosure Form required.

Measles and Rubella immunization required for selectees born after 1957 and seasonal influenza immunization is required for all staff working in Indian Health Service health care facilities.

COVID-19 vaccination is required for all selectees prior to entrance on duty.

Successfully pass the E-Verify employment verification check. To learn more about E-Verify, including your rights and responsibilities, visit www.dhs.gov/E-Verify/.

You will need to set up direct deposit so we can pay you.

Background Investigation: If you are selected for this vacancy, you must undergo a pre-employment fingerprint check and background investigation. Fingerprint results and background investigation documentation must be cleared prior to hire. After you begin your employment, your continued employment is contingent upon the outcome of a complete background investigation as determined by the sensitivity level of your position. The investigation must find that you are suitable for Federal employment in your position. If you are found not suitable, you will be terminated after you begin work. If you make a false statement in any part of your application, you may not be hired; you may be fired after you begin work; or subject to possible criminal charges. You may be subject to a credit check as a part of the background investigation process.

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/. Other Information

Per IHS policy (SGM 21-04) IHS selectees to positions located in Federally operated hospitals, health centers, and clinics must be fully vaccinated for COVID-19 before entry on duty or have IHS approve a medical or religious exemption. If an exemption is approved then wearing a face mask and regular testing for COVID-19 will be required. Your Human Resources Specialist will provide a list of documents acceptable as vaccination proof and instructions on how to submit your vaccination documentation or how to request a medical or religious exemption, if needed.

Additional selection(s) of candidates may be possible within 240 days from the date the certificate of eligibles was issued for this announcement.

Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. IHS may offer newly-appointed Federal employees credit for their directly related previous non-federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which they earn annual leave.

• This position is covered by a Bargaining Unit.
• No recruitment or relocation incentives authorized.
• No government housing.

This position has promotion potential to the GS-08 grade level. Promotion to the next grade level is at management's discretion and is based on your demonstrated ability to perform the higher level duties, the continuing need for the higher level duties, and "Regulatory/Administrative" approval. Promotion to the next higher grade level is not guaranteed and no promise of promotion is implied.

Required Documents

Resume: You are highly encouraged to use USAJOBS Resume Builder to ensure all required information is included in your Resume. If you use your own resume, curriculum vitae, or any other written form you choose then you must describe your job-related qualifications that includes beginning and ending dates for paid and non-paid work experience, hours worked per week, month and year of employment for each job title listed, annual salary, and description of job duties. Include name and address of employer; supervisor name and telephone number.

Required as applicable for the purposes of specific eligibility and appointment claim(s), and position requirements:
Indian Preference Applicants: If claiming Indian preference, applicants must provide a completed copy of the Form BIA-4432, "Verification of Indian Preference for Employment in the BIA and IHS Only." Indian preference will not be given unless a properly signed and dated form is submitted with your application, including any verification by an authorized Tribal Representative or BIA Official of tribal enrollment records. For detailed instructions, see form BIA-4432. Refer to BIA-4432 link: https://www.bia.gov/sites/default/files/dup/assets/public/raca/online_forms/pdf/1076-0160_INDIAN-PREF_Expires-10.31.24_508.pdf. When an Indian Preference candidate possesses Veterans preference the rules regarding Veterans preference apply under ESEP and the applicant must provide documentation in order to receive preference.
Veterans Preference: If claiming Veteran's Preference provide a copy of your DD214 Form (Member 4 copy). To claim 10-Point Veterans Preference, submit a SF-15 Application (http://www.opm.gov/forms/pdf_fill/SF15.pdf) along with the appropriate supporting documentation. For additional information regarding Veterans Preference visit: http://www.fedshirevets.gov.
Career Transition Assistance Program (CTAP)/Interagency Career Transition Assistance Program (ICTAP): If you are claiming CTAP/ICTAP, follow the instructions below: http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/ctap_guideline.pdf.
Current or former Federal employee: Include your most recent SF-50 or if Reinstatement eligible include your Career SF-50.
Noncompetitive eligibles: Submit additional documents to prove your eligibility to apply to this vacancy.
Transcripts: You are encouraged to submit copies of transcripts (official or unofficial) although not required at the time of application. You must list your courses including titles, credit hours completed, and grades. Official transcripts will be required after tentative selection and prior to issuing an official job offer.

You must meet the requirements of the job by 11:59 pm (Eastern Standard Time) of the closing date: 12/12/2024

Your resume and any documents submitted will be retained for eight months and may be used at any time during this period. After 8 months, you must reapply to this announcement in order to be considered.

How to Apply

To apply for this position, you must provide a complete Application Package. See required documents below.

1. Click 'Apply' to create an account or log in to your existing USAJOBS account.
2. Follow the prompts to upload your resume and/or supporting documents.
3. Read all Eligibility questions and respond accordingly. .
4. Complete the assessment questions.
5. Verify all required documentation is included in your application package.

The IHS provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application and hiring process, please notify the Human Resources Office (Navajo Area IHS Human Resources, NAVAO-JOBS@ihs.gov, and/or .) The decision on granting reasonable accommodation will be on a case-by-case basis.

For additional questions please see our Frequently Asked Questions (FAQs) found here: http://www.ihs.gov/jobs/index.cfm?module=search&option=faq.

Benefits

A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Learn more about federal benefits.