Clarification from the agency

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.

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Please Take Note: Individuals working at the Wellpinit Service Unit will be under tribal management in March 2025. Public Law 93-638 gave Tribes the authority to contract for the direct operation of Indian Health Service programs serving their tribal members. If you are hired through this job announcement, you will be subject to future employment under the Spokane Tribe of Indians. The tribe can exercise options to utilize Federal personnel on Intergovernmental Personnel Act (IPA) assignments and Memoranda of Agreements (MOA) but future employment is not guaranteed.

MAJOR DUTIES:
If selected candidate is hired at the grade level GS-06, the selected candidate gains experience toward the next level of grade level GS-07 and until the full performance level of GS-08 is achieved. The major duties are listed below.

• Conducts in-depth face-to-face interview or by telephone with patients and/or families to ensure accurate completion of enrollment application. Assist the applicant to ensure State Medicaid enrollment application is thoroughly complete. Advises the patient/family/non-IHS providers of eligibility based on information gathered at the time of a face-to-face interview or by letter form after all necessary information has been reviewed.
• Performs prescreening process for potential eligibility and gathers pertinent information utilized to determine eligibility and potentially eligibility for alternative resources.
• Verifies and determines patient's eligibility for Medicare, Medicaid, Private Insurance, Veteran Administration or other potential alternate resources as appropriate, which are available and accessible to the individual.
• Determines the sufficiency of the documentation submitted for consideration. Initiates action with appropriate office(s) in order to obtain the required documentation or information (i.e. supporting documents and evidence).
• Prepares memoranda for correspondence for the reviewing appeals, identifies deficiencies and recommends appropriate course of action. Performs substantive research in the areas of medical documentation, administrative compliance, inquiries and reports of investigation and standards of conduct/ethics.
• Ensures that Purchased/Referred Care funds are available prior to issuance of obligating documents on behalf of the government. Provides forecasting of weekly document control register balances after each week's obligations have been completed to ensure funds are expended in accordance within the spending plans.
• Initiates medical authorizations and denial of service for inpatient/outpatient/ancillary medical services for eligible IHS beneficiaries. Reviews completed documents for accurate patient information, clinical data, obligation signatures and fiscal data.
• In appeals or denials, employee gathers all necessary information pertinent to the case for the episode of care and completes final review and determination of a reversal and/or affirmed denial. There may be times when the staff will have to write out the draft appeal letter for the patient; especially those for non-English speaking individuals.

Conditions of employment

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.

Adherence to the IHS Employee Immunization Policy, SGM 21-04, and the IHS Circular 2016-04 requiring Measles and Rubella, COVID-19, and seasonal influenza immunizations for staff working in Indian Health Service health care facilities OR an exemption request will need to be submitted.

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.

The following minimum qualifications shows the amounts of education and/or experience required to qualify for Contact Representative positions taken from the appropriate qualification standard.

MINIMUM QUALIFICATIONS For Grade GS-06

• 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 certain type of work and/or tasks.
• Examples include provide clerical duties such as making appointments, data entry, maintaining files, and answering phone calls; Conduct interviews in order to determine patient's eligibility for Purchased/Referred Care services; Issue medical referrals and denial letters for medical services; Communicate with patients regarding medical bills, claim status, and referrals.

MINIMUM QUALIFICATIONS For Grade GS-07

• 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 certain type of work and/or tasks.
• Examples include assess and educate patients in regard to unique health services and program eligibility; Initiate medical authorizations and denial of service for medical services; Prepare and distribute purchase order authorizations for patient care services and ensure prompt payment; Research vendor claims and purchase orders to provide prompt follow-up; Review incoming claims from providers to determine if authorizations are approved or denied.

MINIMUM QUALIFICATIONS For Grade GS-08

• 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 certain types of work and/or tasks.
• Examples include: Prepare and distribute purchase order authorizations for patient care services and ensure prompt payment; Conduct comprehensive patient interviews to determine eligibility for alternate health insurance resources; Provide recommendations to patients on the various health care benefit programs and eligibility criteria based on current health care laws and regulation; Conduct extensive research and providing benefit updates involving changes in rules and regulations for alternate resources; Review financial reports for reconciliation with outstanding accounts and progressive payments to ensure accuracy.

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. Note: Creditable experience is experience of the type (general or specialized), level, and amount specified in the appropriate standard. Applicants are considered to have satisfied the requirement for 1 year of experience through completion of either 12 months or 52 weeks of creditable work experience, whichever comes first.

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 a cut-off date or the closing date of the announcement. Cut-off date(s) are established based on the date the human resources office receives management request for a list of eligibles or every 10 days thereafter. The job announcement is open continuous until the closing date.

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.

• Veterans, i.e. (VEOA, VRA, and 30% or more disabled) - https://www.opm.gov/policy-data-oversight/veterans-services/vet-guide-for-hr-professionals/
• Career Transition Assistance Program (CTAP) - https://www.ihs.gov/jobs/support-documents/
• Interagency Transition Assistance Program (ICTAP) - https://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/
• Schedule A Appointments for the Disabled - https://www.opm.gov/policy-data-oversight/disability-employment/hiring/

Click here to view vacancy questions: https://apply.usastaffing.gov/ViewQuestionnaire/12640838. All documents above MUST be received by 11:59 pm (Eastern Standard Time) of a cut-off date or the closing date of, 03/08/2025, to be considered. Cut-off date(s) are established based on the date the human resources office receives management request or every 10 days thereafter. The job announcement is open continuous until the closing date.