About this role
Job SummaryAt the Indian Health Service, Contact Representatives in Purchased Referred Care ensure patients receive timely access to medically necessary services. They determine eligibility, coordinate alternate resources, and safeguard limited healthcare funds while upholding federal regulations. You play a vital role in connecting American Indian and Alaska Native patients to care. USAJOBS Help Center - Update your resume now so it meets new resume requirements
QualificationsTo 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: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-05 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Experience applying established procedures and standard operating guidelines to process applications or referrals, verify basic eligibility information, and enter data into automated systems. Experience reviewing documents for completeness and accuracy, identifying missing information, and referring complex issues to a higher-level specialist. Experience responding to routine inquiries from applicants or providers regarding program requirements and case status and obtaining information necessary to process cases. 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.
Major DutiesServes as a Contact Representative in Purchased Referred Care administering eligibility determinations in accordance with federal regulations and IHS policy. Conducts detailed interviews with patients and families to verify eligibility for PRC and alternate resources such as Medicare, Medicaid, VA, and private insurance. Issues medical authorizations or denial letters, ensures funds availability prior to obligation, and maintains fiscal controls in compliance with federal requirements. Researches complex cases, interprets regulations, prepares reports, and serves as liaison with providers, tribal entities, and federal, state, and local agencies to ensure continuity of care and appropriate use of funds. All Grade levels MAY NOT be available at all locations.RequirementsSelectee may be subject to a probationary 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. 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/. Selectee(s) are required to have a viable bank account at a financial institution for electronic direct deposit of salary payment. Background Investigation Requirement: This position requires the successful completion of a federal background investigation as a condition of employment. A background investigation is a standard process used by the Federal Government to verify an individual's identity, employment history, education, and other relevant information to determine suitability for Federal service. Upon receipt of instructions, applicants must complete all required background investigation forms within five (5) calendar days of issuance. Timely completion is critical to avoid delays in processing or a determination of unsuitability. Applicants are strongly encouraged to prioritize this requirement and to maintain regular communication with their assigned Personnel Security Specialist throughout the process. Financial Suitability Requirement: This position requires a review of the applicant's financial history as part of the personnel security and suitability determination. Applicants must demonstrate financial responsibility, maintain good standing with creditors, and satisfy all legal financial obligations prior to applying. Individuals with substantial delinquent or unresolved financial obligations-including, but not limited to, delinquent federal or state tax liabilities, defaulted federal student loans, court-ordered fines or fees, or child support arrears-may be deemed unsuitable for employment with the Indian Health Service (IHS).