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The purpose of the position is to administer the provision of Purchased/Referred Care in compliance with regulatory requirements setforth in the 42 CFR, Subpart 136, to determine patient's eligibility, defining and interpreting PRC regulationsand guidelines and maintaining records. Employee identifies and assists patients who may be eligible forcoverage by third party resources. Subject matter expert in determining patient's PRC eligibility and adviseothers as needed.
Duties
- Issue denial letters on a daily basis
- Issue Purchase Orders on a daily basis
- Schedule patient referral appointments
- Prepare ER Notifications for submission to PRC Committee
- $44,117 - $70,578/year
Selectee may be subject to a probationary 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.
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.
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:
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:
Minimum Qualifications, GS-0962-06
One (1) year of specialized experience equivalent to at least a GS-5 grade level. Examples of experience include: implementing screening and interview methods to obtain or verify information; and assisting patients or customers with completing forms and interpretation of rules and regulations and coordinating work with other organizations or parts of the organization.
Minimum Qualifications, GS-0962-07
One (1) year of specialized experience equivalent to at least a GS-6 grade level. Examples of experience 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.
Minimum Qualification, GS-0962-08
One (1) year of specialized experience equivalent to at least a GS-7 grade level. Examples of experience 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.
You must meet all qualification requirements within 30 days of the closing date of the announcement. Education There are no education requirements. This position is being announced concurrently under the Excepted Service procedures. Please review vacancy announcement number IHS-25-GP-12605413-ESEP; for eligibility requirements. NOTE: Applicants must apply separately for each announcement in order to be considered. 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.
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.
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
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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.
Licensure, Certifications: Applicants should list their license/certifications on their resume, along with the expiration date, if applicable. Certification of licensure/certification 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 (Eastern Standard Time) of the closing date: 12/13/2024
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
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.
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.
