These 3 vacancies are located at the Colorado River Service Unit (CRSU). Peach Springs Health Clinic in Peach Springs, AZ or at the Southern Bands Health Clinic located in Elko, NV. This position provides Lead support for the Patient Business Office (PBO) Department or the Purchased Referred Care (PRC) department. The incumbent is part of a team that is responsible for proving medical support assistance to the PBO/PRC team for the assigned department.
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. GS-08: MINIMUM QUALIFICATIONS: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-07) grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: LEAD experience examples include: Served as a work leader, distributed and balanced a workload, coordinate and manage employee workloads, provide reporting and status on departmental operations, provides instructions and resources for employes to accomplish assigned tasks, provide on the job training, coordinate or oversee a leave calendar. PURCHASED REFERRED CARE experience examples include: Applying rules and procedures and regulations under the Purchased Referred Care (PRC) program; implementing PRC budget funding limitations; advising others of procedural and regulatory requirements; and assisting in the management of PRC transactions while submitting authorizations through proper channels. PATIENT BUSINESS OFFICE experience examples include: Experience working in accounts receivable providing medical posting and batching payments, follow up on non-payments, Reviews incoming correspondence determining whether the claim is final; or more medical information is needed; or claim needs to be resubmitted; or appropriate biller, as needed and/or posted as a true denial. Communicates directly with third party payers on the eligibility of patients, Prepares final data for submission to Treasury for collections for the Third-Party Billing department. Denial Managment experience, Serves as contact person in providing medical support assistance relative to any questions or problems with denial management (billing), Responds to third party requirements on post-payment reviews, exclusions, denials and appeals, Responsible for reviewing claim upon receiving, until claim has been paid by Third Party Payer. 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.
Total Compensation Package - Check out IHS's outstanding total compensation package for this job: Medical Support Assistant Total Compensation | Pay (ihs.gov) Lead Duties: Serves as work leader, responsible for substantially assuring that the work assignments of other employees of the group are carried out. Typical duties include, but are limited to: Distributes and balances the workload amount employees in accordance with established workflow or job specialization, assures timely accomplishment of the assigned workload, and assures that each employee has enough work to keep busy with adequate working conditions. Keeps in touch with the status and progress of work, and makes day-to-day adjustments in accordance with established priorities, obtaining assistance from the supervisor on problems that may arise, such as backlogs, which cannot be disposed of promptly. Instructs employees in specific tasks and job techniques and makes available written instruction, reference materials, and supplies. Gives on-the-job training to new employees in accordance with established procedures and practices; approves leave for few hours for emergencies. Accounts Receivable Leads a team in provide medical support assistance for the Service Unit by providing medical posting and batching payments received on a daily basis. Also follows-up on non-payments, adjustments and refunds to ensure staff are following established guidelines. Accesses appropriate data after preparing a logical search strategy and structuring the requirement and acceptable identifiers. Reviews incoming correspondence determining whether the claim is final; or more medical information is needed; or claim needs to be resubmitted; or appropriate biller, as needed and/or posted as a true denial. Notifies the insurance carrier within the timeframes required. Denial Management (Billing) Serves as contact person in providing medical support assistance relative to any questions or problems with denial management (billing). Such contacts involve a variety of program related matters, interpretation of regulatory material and determining the applicability of guidelines and instructions to problems or situations that, in many instances, are not specifically covered. Makes recommendations for changes in methods and procedures, information dissemination and other denial management to resolve recurring problems and expedite processing actions. Responds to third party requirements on post-payment reviews, exclusions, denials and appeals. Actively performs audits and medical reviews to ensure documentation and accountability of all health insurance claims submitted for payment by conducting random sample reviews. PRC (Purchase Referred Care) Medical Support Duties: Oversees and coordinates the daily operational functions of the service unit's Purchase Referred Care Health Services Program in providing medical support assistance. Acts as patient advocate to resolve payment questions and payer responsibilities to vendors and providers of contracted and/or non-purchase referred care health care services. Acts as liaison for the service unit to vendors, providers, other IHS agencies and outside agencies to maintain a positive working relationship with all agencies; to improve and to maintain positive communications and to provide guidance to outside agencies on IHS policies and procedures. Responsible for the Purchase Referred Care Health Services Quality Assurance Program.