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Program Analyst, Medical Claims and Provider Network (O-4 Billet) Non-Supervisory

Department of Homeland Security
Immigration and Customs Enforcement
ICE Health Service Corps (IHSC)
This job announcement has closed

Summary

This position is located within the Department of Homeland Security (DHS), Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO), ICE Health Service Corps (IHSC), Office of Deputy Assistant Director for Healthcare Compliance, Office of Health Plan Management Unit (HPMU). This is a non-supervisory position.

This position is only open to USPHS officers and Call to Active Duty (CAD) candidates.

Overview

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Hiring complete
Open & closing dates
02/06/2024 to 02/20/2024
Salary
$1 to - $150,000 per year

Please note that the salary is dependent on the officer's rank, years in service, and location of duty station.

Pay scale & grade
CC 4
Location
1 vacancy in the following location:
Anywhere in the U.S. (remote job)
Remote job
Yes - Please note that upon selection, the candidate must live within 100 miles of an IHSC Field Office.
Telework eligible
Not applicable, this is a remote position.
Travel Required
25% or less - You may be expected to travel for this position.
Relocation expenses reimbursed
Yes—You may qualify for reimbursement of relocation expenses in accordance with agency policy.
Appointment type
Permanent
Work schedule
Full-time
Service
Excepted
Promotion potential
None
Job family (Series)
Supervisory status
No
Security clearance
Other
Drug test
Yes
Position sensitivity and risk
Critical-Sensitive (CS)/High Risk
Trust determination process
Announcement number
IHSC-MCPN-PA-O4-NS-2024
Control number
774903300

This job is open to

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The public

U.S. Citizens, Nationals or those who owe allegiance to the U.S.

Clarification from the agency

Applicants must be a current USPHS Commissioned Corps Officer or USPHS Call to Active Duty (CAD) candidate. Civilians are not eligible for this position.

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Duties

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DUTIES AND RESPONSIBILITIES:

  1. Serves in the capacity a Claims Management Program Analyst handles and assists program activities and policies related to medical claims, and provider recruitment.
  2. Duties include assisting in day to day managing, assessing, planning, developing, implementing, and evaluating assigned programs. Incumbent assists with reviews of policies. Incumbent ensures compliance with program regulations (e.g., appropriateness of health care and services based on regulatory, reimbursement requirements, evidence-based national care guidelines and evidence-based practices), maintains records per program policy, coordinates and, or manages programs within immediate organizational component. Communicates and collaborates with individuals or groups from outside the agency, including consultants and contractors. Work purpose is primarily to collaborate; supply advice; explain, interpret, and seek support for methods, policies and programs; or render a service of a moderately complex nature requiring a moderate amount of explanation and tact (e.g., support for budget).
  3. Liaise regionally and, or, nationally with applicable stakeholders internal and external stakeholders (e.g., Customs and Border Patrol, Veterans Affairs) regarding medical claims processes, trainings, and principles.
  4. Provides guidance to the respective ICE, custody, and medical staff members of facilities in which and ICE detainees are held regarding ICE policies, reporting requirements, and applicable ICE detention standards.
  5. Judgmental failure can result in ineffective or inappropriate use of resources and delays in meeting public health objectives of the office or agency. This may also impair the development of systems, affect the work of subordinate employees, and compromise the delivery of other administrative and personnel services.
  6. Travel may be required - estimated 15%
  7. Travels TDY as needed to provide clinical care support at IHSC-staffed detention facilities with critical staffing needs.
  8. Performs other duties and responsibilities as assigned.

Requirements

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Conditions of employment

  • You must be a U.S. citizen to apply for this position.
  • You must successfully pass a background investigation.
  • You must successfully pass a drug screen.
  • Males born after 12/31/59 must certify registration with Selective Service.
  • Requirements by Closing Date: Unless otherwise noted, you must meet all requirements by the closing date of the announcement.
  • Probationary Period: This is a full-time permanent position (Career/Career-Conditional appointment). Upon appointment to this position, you may be required to serve a one-year probationary period.
  • Applicants must be a current USPHS Commissioned Corps Officer or USPHS Call to Active Duty (CAD) candidate. Civilians are not eligible for this position.

Qualifications

PHYSICAL DEMANDS:

  1. Sitting and/or standing for extended periods of time [6-8 Hours].
  2. Performing repeated bending motion.
  3. Average manual dexterity for computer operation.
  4. Phone use for extended periods of time.
  5. Required to walk unaided at a normal pace for up to 5 minutes and maintain balance.
  6. Required to jog/fast walk up to ¼ mile.
  7. Required to perform CPR/emergency care standing or kneeling.
  8. Must have the ability to assist sick, injured, or aging detainees or staff exiting the building (may require lifting, dragging, wheeling, or carrying someone who weighs significantly more than oneself).

Education

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES:

  1. Incumbent must possess a minimum of three years of professional experience relevant to the officer's category. Of the total professional experience, officer must possess at least two years of experience related to management, administration, or evaluation of public health programs. Healthcare management, finance or medical claims is preferred.
  2. Qualifying degree for the officer's category from an accredited institution
  3. If the incumbent holds a clinical license, it is the responsibility of the incumbent to fulfill the obligation(s) of their licensing or certifying body to maintain status. The agency may require the incumbent performs clinical activities with the scope of clinical license in times of critical needs within the agency. If in a clinical discipline and as directed and approved by his/her supervisors, the incumbent may perform clinical duties of their profession in Federal health care facilities. Such direction is documented via a memorandum of assignment and is filed in the eOPF.
  4. Well-developed knowledge and skills in the areas of claims management and medical necessity.
  5. Knowledge of medical, administrative, ethical, and legal requirements and standards related to healthcare delivery.
  6. Should possess some knowledge of International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), current procedural terminology (CPT), diagnosis-related group (DRG), and other Centers for Medicare and Medicaid Services (CMS) coding/billing requirements.
  7. Experience utilizing and navigating electronic health records and other web based application programs.
  8. Ability to critically analyze situations, data, and information, and be able to develop and pose probing questions, identify problems, and make recommendations towards their resolution.
  9. Maintains clinical professional skills via continuing education opportunities.
  10. Computer literate on MS Office applications.

Additional information

This position is located within the Department of Homeland Security (DHS), Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO), ICE Health Service Corps (IHSC), Office of Deputy Assistant Director for Healthcare Compliance, Office of Health Plan Management Unit (HPMU). The incumbent reports directly to the IHSC Medical Claims Program Manager (MCPM). This is a non-supervisory position.

HPMU focuses on medical claims program through the governance of a provider network, claims adjudication and utilization management. HPMU collaborates with the Veterans Affairs Financial Services Center (VAFSC), a third-party medical claims administrator, and offsite providers to establish letters of understanding with IHSC. HPMU also works jointly with IHSC stakeholders: pharmacy; dental; the Behavioral Health Unit; the Medical Case Management Unit; and IHSC headquarters to meet mission initiatives. HPMU trains field medical coordinators, managed care coordinators and referral coordinators to improve processes related to the recruitment and retention of outside providers and claims process workflows to decrease claims denials and increase the number of paid claims.

In Fiscal Year (FY) 2021, the ICE Health Service Corps (IHSC) administered and managed a health care system that provided direct care to over 88,000 detainees housed at 21 designated facilities throughout the nation, to include medical, dental, mental health care, and public health services. Oversaw health care for over 169,000 detainees housed in 150 non-IHSC-staffed facilities, totaling over 53,000 beds. In FY 2021, there were a total of 205,242 individuals in ICE custody, with an average length of stay of 37 days. IHSC also directly supports ICE field office directors on medical issues within their area of responsibility. IHSC executed a budget that approached $316M in FY 2021.


SUPERVISORY CONTROLS
The Claims Management Program Analyst works under the supervision of the IHSC HPMU Supervisory Regional Claims Management Program Analyst.

Assignments are usually of a long-term, recurring, or broadly defined nature. Officer plans, and organizes own work, determines sequence of assignments, selects, and develops methods and seeks assistance from experts only rarely. Work is reviewed feasibility, compatibility with other work, and effectiveness in meeting requirements or expected results and objectives. Guidelines may be applicable to some but not all parts of assignment and may contain some inconsistencies and be partially unconfirmed. Selection and adaption from available possibilities involving a moderate amount of modifications and innovation is required. The officer uses judgement in interpreting and adapting guidelines such as policies, regulations, training precedents and work direction for application to specific cases.

The officer analyses results and recommends changes in guidelines and program policies. Innovations and modifications to accepted procedures must be approved and clearly documented. The officer keeps the supervisor informed of the status on projects and consults with him/her on any significant problems encountered.

How you will be evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

We will review your resume and supporting documentation to ensure you meet the minimum qualification requirements. You may be selected for an interview at the hiring authority's discretion. You will be notified of selection or non-selection.

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