This position is located in the Purchased/Referred Care (PRC) at the Rosebud Service Unit in Rosebud, South Dakota. The purpose of the position is to administer the provision of Purchased/Referred Care in compliance with regulatory requirements to determine patient's eligibility, defining and interpreting PRC regulations and guidelines and maintaining records.
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 processes of purchase orders for services rendered.
Salary
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. IHS Selectees that will work in an IHS health care facility may be subject to Employee Health Policies related to Measles and Rubella, COVID-19, and seasonal influenza immunizations. Vaccine exemption requests may be available according to the National and/or Service Unit guidance. Housing may be available 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-6: One year of specialized experience equivalent to at least the GS-5 grade level. GS-7: One year of specialized experience equivalent to at least the GS-6 grade level. GS-8: One year of specialized experience equivalent to at least the GS-7 grade 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: EXAMPLES OF SPECIALIZED EXPERIENCE GS-6: 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. GS-7: 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. GS-8: 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. 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.
Other Information
Additional selection(s) of candidates may be possible within 240 days from the date the certificate of eligibles was issued for this announcement. This position is covered by a Bargaining Unit. Recruitment or relocation incentives may be authorized. At least a 6 month service agreement will be required. This position meets the criteria specified in pillar number one of the five pillars of the PHS Commissioned Corps. PHS Commissioned Officers interested in performing the duties of this position within the Commissioned Corps MUST apply online under the merit promotion announcement indicated above in order to receive consideration. For more information on PHS Commissioned Corps, visit the website at: https://www.usphs.gov/. This position has promotion potential to the GS-8 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/media_document/1076-0160_indian-pref_expires-04.30.25_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. You must meet the requirements of the job by 11:59 pm (Eastern Standard Time) of the closing date: 08/20/2025
How to Apply
To apply for this position, you must provide a complete Application Package. See required documents below. Click 'Apply' to create an account or log in to your existing USAJOBS account. Follow the prompts to upload your resume and/or supporting documents. Read all Eligibility questions and respond accordingly. . Complete the assessment questions. 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 (Joseph Dudley, Joseph.Dudley@ihs.gov, and/or 605-252-2771.) 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.
