This position is organizationally located in the Purchased/Referred Care (PRC) Branch, Billings Area Office, Indian Health Service and works under the direct supervision of the PRC Branch Chief or designee.
Summary
This position is organizationally located in the Purchased/Referred Care (PRC) Branch, Billings Area Office, Indian Health Service and works under the direct supervision of the PRC Branch Chief or designee.
This job will close when we have received 75 applications which may be sooner than the closing date. Learn more
Salary
$46,696 - $74,250 per year
Pay scale & grade
GS 7 - 9
Location
Billings, MT
2 vacancies
Remote job
No
Telework eligible
Yes—as determined by the agency policy. This position is eligible for workplace flexibilities which may include remote work or telework options, and/or flexible work scheduling. These flexibilities may be requested in accordance with the HHS Workplace Flexibilities policy. https://www.hhs.gov/about/agencies/asa/ohr/hr-library/990-1/index.html.
Travel Required
Occasional travel - You may be expected to travel for this position.
The IHS is required by law to give absolute 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 IHS is an Equal Opportunity Employer.
Review and evaluate the effectiveness and efficiency of the Purchased Referred Care program at facilities serviced.
Develop, coordinate and integrate operational plans in accordance with agency policies and directives pertinent to the administration and management of the Purchased Referred Care and Alternate Resources Program.
Develop statistical data from reports and other sources for purpose to review, approve and recommend changes to the Purchased Referred Care operating budget at facilities serviced,
Monitor Purchased Referred Care spending plan, fund status reports and submit written requests for supplemental funds.
Ensure proper decisions assessed to determine eligibility criteria and denial letters.
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.
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.
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.
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.
BASIC REQUIREMENT(S):
Individual Occupational Requirements
Undergraduate and Graduate Education: Major study -- hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. or
Specialized Experience (for positions above GS-5): Progressively responsible analytical or administrative, or clinical management or supervisory experience in the health care field. This work may have been performed in an operating health care facility or a higher organizational echelon with advisory or directional authority over such facilities. Work must have involved a close working relationship with facility managers and analysis and/or coordination of administrative, clinical, or other service activities, and provided knowledge of the following:
Missions, organizations, programs, and requirements of health care delivery systems;
Regulations and standards of various regulatory and credentialing groups; and
Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement.
In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below.
MINIMUM QUALIFICATIONS: The following shows the amounts of education and/or experience required to qualify for positions covered by this standard.
GS-7: One (1) full year of graduate level education or superior academic achievement or 1 year of specialized experience equivalent to at least GS-5.
GS-9: Master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related or 1 year of specialized experience equivalent to at least GS-7.
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 GS-7: Duties are of a trainee level, provide assistance to supervisor and staff in monitoring expenditures of services provided to beneficiaries; assist with explaining eligibility for services to beneficiaries; drafts correspondence and reports for manager and senior staff review; work with automated financial reporting systems. Establish contacts with private insurance companies to resolve claims, adjudication and adjustment of claims. Provide information orally in response to inquiries concerning status of claims, applications, cases, or other actions pending approval or resolution.
Specialized Experience GS-9: Provide technical support and assistance to program staff and facility staff on matters involving oversight and management of various services, i.e., medical, surgical, dental and ancillary to eligible beneficiaries; perform high cost case management of expenditures to determine cases that may include catastrophic illnesses; advise and educate beneficiaries on eligibility of services; assist with monitoring of fund control and appropriate use of dollars spent on allowed services; audits claims processed for patient eligibility for third part programs ensure proper codes submitted to cover primary provider, diagnosis and clinic. Utilize Current Procedural Terminology (CPT) Codes and ICD-10- CM (International Classification of Diseases 10th revision Clinical Modification) for billing. Research and resolve problems, and posts payments, adjustments, denial codes, and non-payment collections. Establish contacts with private insurance companies to resolve claims, adjudication and adjustment of claims. Provide information orally in response to inquiries concerning status of claims, applications, cases, or other actions pending approval or resolution.
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
If you are using education as a substitute for experience, you are strongly encouraged to submit a copy of your transcripts or a list of your courses including titles, credit hours completed, and grades. Unofficial transcripts will be accepted in the application package. Official transcripts will be required from all selectees prior to receiving an official offer.
Only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education may be credited. Applicants can verify accreditation at the following website: https://www.ed.gov/accreditation.
This position is eligible for workplace flexibilities which may include remote work or telework options, and/or flexible work scheduling. These flexibilities may be requested in accordance with the HHS Workplace Flexibilities policy. https://www.hhs.gov/about/agencies/asa/ohr/hr-library/990-1/index.html.
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.
This position is covered by a Bargaining Unit.
This position has promotion potential to the GS-11 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.
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. Opens in a new windowLearn 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.
How you will be evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.
To determine if you are qualified for this position, a review of your resume and supporting documentation will be made and compared against the qualifications as defined in the qualifications section of this vacancy announcement and your responses to the assessment questions.
You will be further evaluated/rated based on the information provided in your resume (your resume must state specific duties that relate to this position) and your responses to the assessment questions to determine your competency in the following.
Financial Management
Oral Communication
Planning and Evaluating
Reasoning
Technical Competence
You will receive a numeric rating based on your responses to the assessment questionnaires. If after reviewing your resume and responses to the assessment questions, a determination is made that you have overstated your qualifications and or experience, you may lose consideration.
The following links below provide information on how you may be eligible for various hiring authorities. If you are a Veteran, qualified CTAP and ICTAP eligible, or an individual with a disability, please refer to the following links below for additional guidance. CTAP and ICTAP candidates will be eligible for selection priority if it is determined that they have exceeded the minimum qualifications for the position by attaining at least a "well qualified" rating of 85 out of 100. Information about CTAP and ICTAP eligibility is on the Office of Personnel Management's Workforce Restructuring Career Transition website at: https://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/. CTAP/ICTAP documentation requirements are listed in the "Required Documents" section of this announcement.
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. Opens in a new windowLearn 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.
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. Current or former Federal employee: Include your most recent SF-50 or if Reinstatement eligible include your Career SF-50. Noncompetitive eligibles: Submit additional documents to prove your eligibility to apply to this vacancy. 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. Superior Academic Achievement:
If claiming eligibility for Superior Academic Achievement, candidates must provide copies of transcripts (official or unofficial) must be included at the time of initial application. If unable to obtain transcripts, candidates must provide sufficient evidence to validate courses completed and credit hours earned. Eligibility is based on one of the following:
Class standing - Applicants must be in the upper third of the graduating class in the college, university, or major subdivision and based on completed courses.
Grade-point average (G.P.A.) - Applicants must have a G.P.A. of: a.) 3.0 or higher out of a possible 4.0 (''B" or better) as recorded on their official transcript, or as computed based on 4 years of education, or as computed based on courses completed during the final 2 years of the curriculum; or b.) 3.5 or higher out of a possible 4.0 ("B+" or better) based on the average of the required courses completed in the major field or the required courses in the major field completed during the final 2 years of the curriculum.
Election to membership in a national scholastic honor society - Applicants can be considered eligible based on membership in one of the national scholastic honor societies listed here Association of College Honor Societies. Official transcripts may be required after tentative selection and prior to issuing an official job offer.
You must meet the requirements of the job by 11:59 pm (Eastern Standard Time) of the closing date: 10/06/2023
If you are relying on your education to meet qualification requirements:
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
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.
The IHS provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application and hiring process, please notify the Human Resources Office (Cindy Bedeau, cindy.bedeau@ihs.gov, and/or 406-208-2732.) The decision on granting reasonable accommodation will be on a case-by-case basis.
Billings Area Indian Health Service
2900 4th Avenue North
Billings, MT 59101
US
Next steps
You can track the progress of your application package via your USAJobs account. You will receive an acknowledgement from USAJobs that your submission was successful once we have received your on-line occupational questionnaire, resume, and any supporting documentation. You will be notified of the status of your application via your USAJobs Account after we conduct a qualification review of your complete application package. You will be contacted if further evaluation or interviews are required. Any exaggeration of your experience, false statements, or attempt to conceal information may disqualify you for employment consideration. We may verify all information you provide in your resume and questionnaire responses, through reference and/or background check, and/or verification of your education. If you are selected, you will be contacted personally by the human resources office posting this announcement.
If all required documentation is not submitted with your application you will lose consideration. It is the applicant's responsibility to verify that information and documents entered, uploaded, or faxed are received, legible and accurate. HR will not modify answers submitted by an applicant.
HHS has a critical preparedness and response mission: HHS protects the American people from health threats, researches emerging diseases, and mobilizes public health programs with domestic and international partners. In support of this mission, HHS offers its employees the opportunity to volunteer to become Federal Civilian Detailees and contribute their unique skills through voluntary temporary assignments to humanitarian emergencies or Departmental priorities countering new and emerging health, safety, and security threats.
~ ~ ~ Indian Health Service is an Equal Opportunity Employer ~ ~ ~
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
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. Current or former Federal employee: Include your most recent SF-50 or if Reinstatement eligible include your Career SF-50. Noncompetitive eligibles: Submit additional documents to prove your eligibility to apply to this vacancy. 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. Superior Academic Achievement:
If claiming eligibility for Superior Academic Achievement, candidates must provide copies of transcripts (official or unofficial) must be included at the time of initial application. If unable to obtain transcripts, candidates must provide sufficient evidence to validate courses completed and credit hours earned. Eligibility is based on one of the following:
Class standing - Applicants must be in the upper third of the graduating class in the college, university, or major subdivision and based on completed courses.
Grade-point average (G.P.A.) - Applicants must have a G.P.A. of: a.) 3.0 or higher out of a possible 4.0 (''B" or better) as recorded on their official transcript, or as computed based on 4 years of education, or as computed based on courses completed during the final 2 years of the curriculum; or b.) 3.5 or higher out of a possible 4.0 ("B+" or better) based on the average of the required courses completed in the major field or the required courses in the major field completed during the final 2 years of the curriculum.
Election to membership in a national scholastic honor society - Applicants can be considered eligible based on membership in one of the national scholastic honor societies listed here Association of College Honor Societies. Official transcripts may be required after tentative selection and prior to issuing an official job offer.
You must meet the requirements of the job by 11:59 pm (Eastern Standard Time) of the closing date: 10/06/2023
If you are relying on your education to meet qualification requirements:
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
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.
The IHS provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application and hiring process, please notify the Human Resources Office (Cindy Bedeau, cindy.bedeau@ihs.gov, and/or 406-208-2732.) The decision on granting reasonable accommodation will be on a case-by-case basis.
Billings Area Indian Health Service
2900 4th Avenue North
Billings, MT 59101
US
Next steps
You can track the progress of your application package via your USAJobs account. You will receive an acknowledgement from USAJobs that your submission was successful once we have received your on-line occupational questionnaire, resume, and any supporting documentation. You will be notified of the status of your application via your USAJobs Account after we conduct a qualification review of your complete application package. You will be contacted if further evaluation or interviews are required. Any exaggeration of your experience, false statements, or attempt to conceal information may disqualify you for employment consideration. We may verify all information you provide in your resume and questionnaire responses, through reference and/or background check, and/or verification of your education. If you are selected, you will be contacted personally by the human resources office posting this announcement.
If all required documentation is not submitted with your application you will lose consideration. It is the applicant's responsibility to verify that information and documents entered, uploaded, or faxed are received, legible and accurate. HR will not modify answers submitted by an applicant.
HHS has a critical preparedness and response mission: HHS protects the American people from health threats, researches emerging diseases, and mobilizes public health programs with domestic and international partners. In support of this mission, HHS offers its employees the opportunity to volunteer to become Federal Civilian Detailees and contribute their unique skills through voluntary temporary assignments to humanitarian emergencies or Departmental priorities countering new and emerging health, safety, and security threats.
~ ~ ~ Indian Health Service is an Equal Opportunity Employer ~ ~ ~
Fair and transparent
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
