This position is located in the Purchased Referred Care Department at Shiprock Service Unit, Shiprock, NM. 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.
Summary
This position is located in the Purchased Referred Care Department at Shiprock Service Unit, Shiprock, NM. 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.
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.
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
THIS POSITION IS BEING READVERTISED TO SOLICIT ADDITIONAL APPLICATIONS. APPLICANTS WHO APPLIED PREVIOUSLY NEED NOT REAPPLY UNLESS SUBMITTING UPDATED AND/OR MISSING INFORMATION.
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
Confidential Financial Disclosure Form required.
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
I have 1 year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-05 level in the Federal service as described in the vacancy announcement. Examples include: Retrieve, organize, and prepare medical records upon request. Scan documents. File reports and other pertinent information into the paper record in accordance with regulations. Perform routine clerical duties.
Specialized experience at the GS-07 Level
I have 1 year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-06 level in the Federal service as described in the vacancy announcement. Examples include: Knowledge in policy and regulations related to medical records confidentiality. Analyze and code medical records in automated record systems. File and purge inactive charts. Interact with personnel for corrective coding and data entry.
Specialized experience at the GS-08 Level
I have 1 year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-07 level in the Federal service as described in the vacancy announcement. Examples include: Provide information or rights and benefits of multiple alternate resources and advise patients of nonpayment or approval of claim.
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.
Additional information
Additional selection(s) of candidates may be possible within 90 days from the date the certificate of eligibles was issued for this announcement.
Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. IHS may offer newly-appointed Federal employees credit for their directly related previous non-federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which they earn annual leave.
This position is covered by a Bargaining Unit.
This position has promotion potential to the GS-08 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.
Customer Service (Clerical/Technical)
Oral Communication
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/policy-forms/online-forms. 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.
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, Degrees, Licensure, Certifications: Copies of Transcripts (Official or Unofficial), Degrees, Licenses, and/or Certifications are not required at the time of application. Applicants must list their education history including the type of degree(s) and major of study, and completion or anticipated completion (month and year) on their resume. If a position requires a certain number of credit hours in specific course work for qualification purposes, applicants must submit a transcript (official/unofficial) or provide documentation/list the relevant courses on their resume. Applicants for positions not requiring a certain number of credit hours but a degree may submit a copy of their official/unofficial transcripts or a list of courses including titles, credit hours completed and grades (needed for SAA) but they are not required. However, official transcripts are required after tentative selection and prior to issuing an official job offer. Applicants should list their license/certifications on their resume, along with the expiration date, if applicable.
You must meet the requirements of the job by 11:59 pm (Eastern Standard Time) of the closing date: 07/19/2024
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 (Navajo Area IHS Human Resources, NAVAO-JOBS@ihs.gov, and/or .) The decision on granting reasonable accommodation will be on a case-by-case basis.
Shiprock Service Unit
Hwy 491 N
PO Box 160
Shiprock, NM 87420
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.
~ ~ ~ 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/policy-forms/online-forms. 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.
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, Degrees, Licensure, Certifications: Copies of Transcripts (Official or Unofficial), Degrees, Licenses, and/or Certifications are not required at the time of application. Applicants must list their education history including the type of degree(s) and major of study, and completion or anticipated completion (month and year) on their resume. If a position requires a certain number of credit hours in specific course work for qualification purposes, applicants must submit a transcript (official/unofficial) or provide documentation/list the relevant courses on their resume. Applicants for positions not requiring a certain number of credit hours but a degree may submit a copy of their official/unofficial transcripts or a list of courses including titles, credit hours completed and grades (needed for SAA) but they are not required. However, official transcripts are required after tentative selection and prior to issuing an official job offer. Applicants should list their license/certifications on their resume, along with the expiration date, if applicable.
You must meet the requirements of the job by 11:59 pm (Eastern Standard Time) of the closing date: 07/19/2024
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 (Navajo Area IHS Human Resources, NAVAO-JOBS@ihs.gov, and/or .) The decision on granting reasonable accommodation will be on a case-by-case basis.
Shiprock Service Unit
Hwy 491 N
PO Box 160
Shiprock, NM 87420
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.
~ ~ ~ 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.
