This position is located in the Purchased/Referred Care at an IHS Service Unit. The purpose of the position is to administer the provision of Purchased/Referred Care in compliance 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
Receives notification and referrals for non-IHS and IHS referred care through hard copy or the automated referred care system. Enters or edits all referrals. Ensures accurate data entry in order to retrieve meaningful reports. Ensures that PRC funds are available prior to issuance of obligating documents on behalf of the government. Provides forecasting of weekly document control register balances after each week's obligations have been completed to ensure funds are expended in accordance within spending plans. Maintains complete fund control records for health services funds allotted. Ensures the presence of accurate information, monitors activities and records pertaining to the fiscal management of funds. Identifies problem areas and recommends corrective action. Reconciles the commitment register to the automated financial system. Issues correspondence to patients, health care providers and other agencies regarding eligibility, IHS policy and regulations, including letters of denial of payment where the requirements of the IHS Program are not met.
Salary
Conditions of Employment
Must pass pre-employment examination. 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. 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. 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. The Hiring Manager/Selecting Official may elect to utilize an available flexibility wherein applicants who are actively completing a required professional training program and are expected to complete such program within 8 month(s) of applying, may be deemed tentatively qualified. 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: GS-06: 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: implementing screening and interview methods to obtain or verify information; assisting patients or customers with completing forms and interpretation of rules and regulations; and coordinating work with other organizations or parts of the organization. GS-07: 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: 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. GS-08: 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: 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.
Other Information
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/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: 12/31/2025 The first Cut-off date for receipt/referral of applications to be considered for available vacant positions will be 10 days after the JOA open date. Your resume and any documents submitted will be retained for three 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. 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.
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