This position is located in the Purchased Referred Care
Department at Kayenta Service Unit, Kayenta, AZ. The purpose of the
position is to administer the provision of Purchased Referred care
in compliance with regulatory requirements. Employee identifies and
assists patients who may be eligible for coverage by third party
Learn more about this agency
- Receives notification and referrals for non-IHS and IHS
referred care through hard copy or the automated referred care
- Verifies and determines patient's eligibility for Medicare,
Medicaid, Private Insurance, VA or other potential alternate
- Researches matters thoroughly based on appropriate regulations
or other mandatories prior to rendering work product
- Prepares memoranda for correspondence for the reviewing appeals
officer, identifies deficiencies and recommends appropriate course
- Performs prescreening process for potential eligibility and
gathers pertinent information utilized to determine PRC eligibility
and potentially eligibility for alternative resources
- Conducts in-depth face-to-face interview or by telephone with
patients and/or families to ensure accurate completion of
- Ensures that PRC funds are available prior to issuance of
obligating documents on behalf of the government
- Initiates medical authorizations and denial of service for
inpatient/outpatient/ancillary medical services for eligible IHS
- Maintains complete fund control records for health services
- Issues correspondence to patients, health care providers and
- Assures request for contracts are submitted with work
- Tracks all referrals to non-IHS facilities to include those
referrals to other IHS facilities to support Case Management
Occasional travel - You may be expected to travel for this
0962 Contact Representative
- Interviewers, Medicare
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
Measles and Rubella immunization required for selectees born
after 1957. Seasonal Influenza immunization is required for
civilian health care facility 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
Fingerprinting, as part of the background investigation process,
may be delayed due to COVID-19. All other background investigation
procedures will apply. Be advised that your continued employment
will require you to complete a fingerprint check within 60 days
after notification of return to full operations and successfully
obtaining a favorable background investigation.
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.
GS-06: One (1) year of specialized experience equivalent to the
GS-05 grade level.
GS-07: One (1) year of specialized experience equivalent to the
GS-06 grade level.
GS-08: One (1) year of specialized experience equivalent to the
GS-07 grade level.
Experience that equipped the applicant with the particular
knowledge, skills, and abilities (KSA's) to perform successfully
the duties of the position, and that is typically in or related to
the position to be filled. To be creditable, specialized experience
must have been equivalent to at least the next lower grade level.
Applicants who have the 1 year of appropriate specialized
experience are not required by this standard to have general
experience, education above the high school level, or any
additional specialized experience to meet the minimum qualification
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
Specialized experience at the GS-06 Level
Skilled in conducting patient interview; experience with
assisting patients with completing forms for alternate resources;
ability to interpret rules and regulations; ability to identify and
assist patients with eligibility coverage and third party
resources, determine patient's eligibility for Medicare, Medicaid,
Private Insurance, Veterans Administration, etc. Perform issuance
of documents ie. medical authorizations. Maintain fund control
records. Ability to track referrals.
Specialized experience at the GS-07 Level
Receives notifications and referrals for health care facility,
verifies and determines eligibility for coverage; extracts
statistical data to prepare and submit reports; ability to forecast
weekly control registers and obligations; review incoming claims
for determination; explain and interpret regulations and policies
to patients and providers; maintain appeal records for appeal
process; perform case by case interviews, data gathering and
ability to research to determine approval/denial of cases. Monitor
activities and records pertaining to fiscal management of funds,
tracks referrals for case management purposes. Experience in
medical terminology and basic human anatomy.
Specialized experience at the GS-08 Level
Ability to define and interpret regulations and guidelines for a
direct care health service. Ability to govern administration and
apply program rules; provides expertise for Medicare, Medicaid,
Social Security Administration, Tribal Programs, etc., eligibility
requirements; Ability to conduct extensive searches for information
and reconstruction of cases; ability to adjudicate, analyze,
provide advice on appeal cases, skilled in compiling and writing
reports; ability to make decisions regarding authorized documents.
Skilled in fiscal coding procedures with accurate accountability of
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.
There are no education requirements.