This position is located with the Division of Purchased/Referred Care at the Gallup Indian Medical Center in Gallup, NM. 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 regulations and guidelines and maintaining records. Employee identifies and assists patients who may be eligible for coverage by third party resources.
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: 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: Conducting patient interviews in order to determine eligibility of alternate funding and resources. Advise and assist individuals requesting services with a variety of problems, questions, or situations in compliance with services using alternate health care resources. Assisting patients with completing forms for alternate resources (ie. Medicare, Medicaid, Private Insurance, etc.) 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: Identifies and assists patients who may be eligible for coverage by third party resources. Extracts statistical data to prepare and submit reports. Reviews incoming claims for determination. Explains and interprets regulations and policies to patients and providers. Perform case by case interviews, data gathering and research to determine approval/denial of cases. 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: Performs prescreening process for potential eligibility and gathers pertinent information utilized to determine eligibility and potentially eligibility for alternative resources. Analyzes the facts of individual cases and researches regulations and guidelines. Conducts in-depth face-to-face interview or by telephone with patients and/or families. Maintains program files including letters of denials with all backup material for reason for denial, elective procedures, etc. Conducts regular internal review and verification of computerized financial reports. Coding procedures which requires the accurate accountability of funds. 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.
Performs prescreening process for potential eligibility and gathers pertinent information utilized to determine eligibility and potentially eligibility for alternative resources. Verifies and determines patient's eligibility. Compiles and interprets various alternate resource references and guides. Initiates medical authorizations and denial of service for inpatient/outpatient/ancillary medical services for eligible Indian Health Services (IHS) beneficiaries. Ensures and maintains internal (Service Unit) fiscal controls by utilizing appropriate fiscal and accounting codes on funds being obligated. Answers technical correspondence, compiles information and prepares periodic and special reports. Issues correspondence to patients, health care providers and other agencies regarding eligibility. Maintains program files including letters of denials with all backup material for reason for denial, elective procedures, etc. Tracks all referrals to non-IHS facilities to include those referrals to other IHS facilities to support the Case Management activities and continuity of care efforts