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Contact Representative

Company: Department Of Health And Human Services
Location: Kayenta
Posted on: May 3, 2021

Job Description:

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Duties

Summary

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 resources.

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Responsibilities

  • Receives notification and referrals for non-IHS and IHS referred care through hard copy or the automated referred care system
  • Verifies and determines patient's eligibility for Medicare, Medicaid, Private Insurance, VA or other potential alternate resources
  • 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 of action
  • 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 enrollment application
  • 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 beneficiaries
  • Maintains complete fund control records for health services funds allotted
  • Issues correspondence to patients, health care providers and other agencies
  • Assures request for contracts are submitted with work specifications
  • Tracks all referrals to non-IHS facilities to include those referrals to other IHS facilities to support Case Management activities

Travel Required

Occasional travel - You may be expected to travel for this position.

Supervisory status

No

Promotion Potential

8

  • Job family (Series)

0962 Contact Representative

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  • Requirements

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Requirements

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 12/31/1959

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 process.

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.

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: 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.

Specialized Experience

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 requirements.

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:

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 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.

Education

There are no education requirements.

Keywords: Department Of Health And Human Services, Saint George , Contact Representative, Other , Kayenta, Utah

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