About this role
Job SummaryThe position is located in the Business Office of the Northern Cheyenne Service Unit. The primary purpose of this position is to abstract and interpret data from records in preparation and submission of third party claims. The incumbent reports to the Business Office Manager. A REAL ID will be required beginning May 7, 2025, in accordance with 6 C.F.R. 37.5 (2021).
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: 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: GS-5: 1 year of specialized experience: Examining alternate resource claims, verifying health claim numbers, reviewing reports, submitting claims to third party, and submitting daily billing productivity report.; OR 4 years of education above the high school level; OR a combination of education and experience that when combined fully meet the minimum qualifications for this position. Only education in excess of the first 60 semester hours is creditable toward meeting the specialized experience requirement. The total percentage must equal at least 100 percent to qualify an applicant for GS-05 grade level. GS-6: 1 year of specialized experience: Documenting activities on patient accounts, providing technical assistance, maintaining unbilled claims, correcting errors, updating systems, identifying errors and duplicates. 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 DutiesAnalyze, maintains, and directs the billing operation for third party programs. Responds to third party requirements on post-payment reviews, exclusions, denials, and appeals. Performs audits and medical reviews on all health insurance claims. Provides referrals for third party eligible patients. Responds to administrative inquiries and departmental needs. Provides orientation and training for departmental staff and other health care facilities.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 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 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).