Job Overview

Summary

The Indian Health Service is required by law to give preference to qualified applicants who meet the Secretary of the Interior's definition of Indian for appointment to vacancies within the IHS in accordance with established IHS policy as outlined in the Indian Health Manual Part 7, Chapter 3. The Indian Health Service is an Equal Opportunity Employer.

The IHS is the principal federal health care provider and health advocate for American Indians and Alaska Natives (AI/AN). The IHS goal is to raise Indian health status to the highest possible level. IHS provides leadership and direction to programs and activities designed to improve health outcomes to over 1.9 million AI/AN through a system of IHS, Tribal and Urban operated facilities and programs. For information on the IHS visit IHS.GOV.

 

The Indian Health Service is required by law to give preference to qualified applicants who meet the Secretary of the Interior's definition of Indian for appointment to vacancies within the IHS in accordance with established IHS policy as outlined in the Indian Health Manual Part 7, Chapter 3. The Indian Health Service is an Equal Opportunity Employer.

 

The mission of the Office of Resource Access and Partnerships (ORAP) is to provide Agency-wide leadership and consultation to IHS direct operations and Tribal programs on IHS goals, objectives, policies, standards, priorities and methods regarding the operations and management of the Business Office Service (BOS), Contract Health Services (CHS) and IHS Partnership programs. This position is located in the Office of Resource Access and Partnerships (ORAP), Headquarters, Indian Health Service (IHS), Rockville, Maryland.

 

The purpose of this position is to work with the Division of Business Office Enhancement (DBOE) and the Division of Contract Care (DCC) to provide medical input on health care matters in an effort to improve their effectiveness and efficiency. The incumbent will: obtain and evaluate evidence needed to determine the medical appropriateness of appeals for denied contract care; provide expert medical advice and recommendations on IHS medical billing practices; and consult on IHS contract health care delivery activities and review and maintain priorities on healthcare services that contract health care funds are used for. The incumbent will be responsible for managing ORAPs regulatory program and coordinating ORAP regulatory efforts with the OMS Branch of Regulations and Records Access.  

 

The incumbent reports to the Director ORAP who in-turn reports to the Deputy Director, Management Operation, IHS.

Who may apply

  • Merit Promotion Plan (MPP); these are current or former Civil Service employees; PHS Commissioned Officers; or Veterans applying under VEOA
  • Excepted Service Examining Plan (ESEP: American Indians and Alaska Natives with no prior federal experience.

See Jobs at IHS.gov for more details

Duties

  • Analyzes and evaluates appeals of medical denials for Contract Care for cases denied for medical reasons by the facility and the Area Office. Counsels CHS management staff on all matters involving appeals of denied contract care due to them not being in a medical priority or not deemed a medical emergency. Provides advice and guidance as to whether to uphold or overturn the denial made at the Area level.

 

  • Review and Analyze Healthcare Laws and Regulations that pertain to purchasing high quality medical care from the private sector and providing care in house to assure that Indian Health programs meet all medical policy and regulatory requirements. Advices ORAP when current IHS regulations effecting third party collections or payment for contracted health services need to be written or changed to bring about program enhancement and leads the effort to write or change the regulations. Coordinates regulatory activities with other HHS Agencies on regulations that impact on the collection for services provided or reimbursement for health care purchased by Indian Health programs.

 

  • Medical Liaison to Centers for Medicare and Medicaid on regulatory/operational issues affecting health care delivery and the level of third party reimbursements from Medicare, Medicaid, S-CHIP and other programs of the CMS. As liaison, incumbent provides policy information to CMS focusing on medical implications and concerns, management and guidance to IHS staff and/or serves directly on national workgroups set up by IHS executive management for assessing and developing legislation, program policy/regulations, reimbursement policy and managed care policy initiatives.

 

  • Contract Health Services Third Party Collections Program Reviews are performed on Area and facility Business and Contract Health Offices for medical services appropriateness by either IHS staff or contracted staff. After the review they will follow up on corrective actions or improvements suggested by the review team to assure that a corrective action plan is developed and carried out. If needed the incumbent will provide either directly or through third parties needed technical assistance to carry out the corrective action plan.

  • Contract Health Services Medical Priority List for IHS is developed and maintained in conjunction with the IHS Chief Medical Officer. In this capacity the incumbent works with the Area CHSOs and Chief Medical Officers to assure that the IHS HQ and the Area's CHS Medical Priority list are current and relates to disease prevalence of AI/AN people.