Contact Representative

This position is located in the Purchased Referred Care Department at the Nashville Area Indian Health Service. The purpose of the position is to administer the provision of Purchase/Referred Care (PRC) in compliance with regulatory requirements to determine patient's eligibility for third party resources. This position is Remote and located under the Nashville Area Office, Nashville, TN.

Duties

• Receives, enters, and edits all non-IHS and IHS referrals.
• Verifies and determines patient's eligibility for third party resources.
• Performs research related to medical documentation, administrative compliance, and inquiries.
• Conducts virtual interviews or by telephone to gather pertinent information related to patient care.
• Ensures PRC funds are available prior to issuance of obligating documents on behalf of the government.
• Initiates medical authorizations.
• Gathers all necessary information for appeals or denials.
• Prepares periodic and special reports.
• Perform other duties as assigned.

Salary

• $44,117 - $70,578/year

Conditions of Employment

Selectee may be subject to a probationary/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.

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.

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-06 grade level: One (1) year of specialized experience equivalent to the GS-05 grade level.
GS-07 grade level: One (1) year of specialized experience equivalent to the GS-06 grade level.
GS-08 grade level: One (1) year of specialized experience equivalent to the GS-07 grade level.

Specialized Experience:
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: Please see grade level specialized experience examples below.

Specialized experience at the GS-06 Level:
One (1) year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-05 level in the Federal service as described in the vacancy announcement. Examples include: Working with a health care delivery system or similar system to respond to inquiries from individuals as they relate to the type of health services the medical facility can provide and to solve problems or educate individuals about medical facility health programs and procedures including tasks such as assisting patients in applications for entitlement for health related programs, interviewing patients and or a family member to obtain pertinent and accurate information, research current information involving changes in rules and regulations for alternate resources and determines the eligibility of patients seeking healthcare.

Specialized experience at the GS-07 Level:
One (1) year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-06 level in the Federal service as described in the vacancy announcement. Examples include: Work experience that demonstrates knowledge of eligibility requirements for health care benefit programs such as Medicare, Medicaid, Social Security Insurance, and other similar resources to help patients in applying for alternate resources if not directly eligible for health services the medical facility can provide including experience in interviewing clients for information and advising customers on various health care benefits and eligibility based on current health care laws, regulations, policies and procedures.

Specialized experience at the GS-08 Level:
One (1) year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-07 level in the Federal service as described in the vacancy announcement. Examples include: work experience that demonstrates comprehensive knowledge of rights and benefits of multiple alternate resources; advise patients of nonpayment or approval of claim; compile and write reports; contact alternate resources to explore reasons for adverse decision, the possibility of reconsideration, whether there are grounds for appeal; complete contacts independently including review of complex records, reconstruction of involved transactions, analysis of precedent decisions.

You must meet all qualification requirements within 30 days of the closing date of the announcement. Education There are no education requirements. 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.

This position is eligible for workplace flexibilities which may include remote work or telework options, and/or flexible work scheduling. These flexibilities may be requested in accordance with the HHS Workplace Flexibilities policy. https://www.hhs.gov/about/agencies/asa/ohr/hr-library/990-1/index.html.

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.

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.

You must meet the requirements of the job by 11:59 (Eastern Standard Time) of the closing date: 12/20/2024

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

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.