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 AND RESPONSIBILITIES:

1. Serves in the capacity of a U.S. CBP Program Analyst (CBP PA); represents CMP and assists in program activities, and policies related to CBP's Office of Field Operations (OFO) and Homeland Security Investigations (HSI), medical payment authorization request application system (MedPAR2), claims adjudication, and provider recruitment with the goal of becoming a subject matter expert.
2. Assumes leadership role as acting CBP Program Analyst Lead (CBP PAL) when necessary.
3. Serves as CMP representative between IHSC, third-party administrator, U.S. CBP components, and ICE ERO in CMP program related activities.
4. Assist in developing, evaluating, and coordinating CMP related functions to ensure adherence to industry practices in eligibility verification, authorization of care, claims management denials and appeals to minimize adverse outcomes related to timely filing and maintaining a Provider Network to provide quality specialty care to illegal aliens.
5. Provides oversight and consultation while reviewing, approving, denying, and adjudicating Medical Payment Authorization Requests (MedPAR)/referral for reimbursable healthcare services submitted by U.S. CBP, OFO, and HSI.
6. Duties include assisting in day-to-day managing, assessing, planning, developing, implementing, and assigned duties.
7. Completes recurring assignments with minimal instructions; however, objectives, priorities and deadlines are provided on new assignments.
8. The incumbent selects his/her own methods and solves most normal problems arising during the course of work. Completed work is usually evaluated for technical soundness, appropriateness and conformity to professional standards and PHS requirements.
9. Incumbent assists with program compliance 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 manages delegated assignments within immediate organizational component.
10. 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; and render a service of a moderately complex nature requiring a moderate amount of explanation and tact.
11. Liaise regionally and nationally with applicable internal and external stakeholders (e.g., U.S. Customs and Border Protection, TPA) regarding medical claims processes, trainings, and principles.
12. Assists with providing orientation and guidance to the respective U.S. CBP, ICE, custody, and medical staff members of facilities in which U.S. CBP and ICE aliens are held regarding ICE policies, reporting requirements, and applicable ICE detention standards.
13. Provides consultation to U.S.CBP, ICE, and custody regarding Medical Payment Authorization Requests (MedPARs) for reimbursable health care services and medical claims review.
14. Collaborates with the Claims Management Program to reconcile and resolve denied off-site community provider claims and appeals.
15. Assist TPA in coordinating and obtaining information pertaining to referrals or eligibility in the alien tracking system.
16. Provides consultation to U.S. CBP for recruitment and enrollment of off-site community providers into the IHSC provider network.
17. Judgmental failure could seriously affect the social, physical, and economic well-being of one or more individuals. Failure may waste efforts and resources of others. Impact of error can cause serious delays in service of others.
18. Travel may be required estimated 15%.
19. Travel TDY as required.
20. Perform other duties and responsibilities as assigned.

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.
• Service Remaining Requirement Agreement: Upon appointment to this position, officers will be required to serve an 18 to 24-month commitment to IHSC.
• ASSIGNMENT PAY AGREEMENT: You must not have a current Assignment Pay Agreement. However, if you have a current Assignment Pay Agreement, it must be fulfilled within 90 days of your application submission.
• Applicants must be a current USPHS Commissioned Corps Officer or USPHS Call to Active Duty (CAD) candidate. Civilians are not eligible for this position.
• Applicants without a USPHS commission must begin the USPHS Commissioned Corps application process before applying to this position. Applicants must review the USPHS application requirements and submit an application at www.usphs.gov/apply-now/.
• Continued employment is contingent upon appointment to, and maintenance of, active-duty status in the USPHS Commissioned Corps.
• PHS officers must participate in IHSC TDY On-Call Schedule (ITOS.) ITOS is either an entire month or two 16-day periods a year where, depending on the needs of the agency, the officer is required to be available to serve.

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 illegal aliens or staff exiting the building (may require lifting, dragging, wheeling, or carrying someone who weighs significantly more than oneself).

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.