This position is located in the Third Party Billing Section of the CRSU, Patient Business Office, in Parker, Arizona. This position is under the Supervision of the Financial Manager. The primary function of this position is to manage department with responsibility, accountability, direct and coordinate 3rd party resources.
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. BASIC REQUIREMENT(S): Individual Occupational Requirements Undergraduate and Graduate Education Major study-- hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. OR Specialized Experience: Progressively responsible analytical or administrative, or clinical management or supervisory experience in the health care field. This work may have been performed in an operating health care facility or a higher organizational echelon with advisory or directional authority over such facilities. Work must have involved a close working relationship with facility managers and analysis and/or coordination of administrative, clinical, or other service activities, and provided knowledge of the following: Missions, organizations, programs, and requirements of health care delivery systems; Regulations and standards of various regulatory and credentialing groups; and Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement. MINIMUM QUALIFICATIONS, GS-0671-12: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the 11 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Provides or assisted with providing management oversight and accountability for administrative and management services related to Business Office, Purchased Referred Care, Health Information Management and/or IT. Follows established policies and procedures of a Business Office, Purchased Referred Care, Health Information Management and/or IT, determines if program is functioning efficient and effectively to meet established requirements. 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.
Serves as the primary Insurance Credentialing for PBO. Ensures all applications to Medicare, Medicaid and any Private Insurance companies are completed to specifications. Maintains Medicare, Medical and private/commercial insurance manuals and directives, Providers Reimbursement Manual, Direct Dealings, Provider Letters, and Federal Health Insurance for the aged, Transmittals of bills, vouchers and schedules and any addendums to the ICD-9-CM Coding volumes. Supervises the filing of all pending and completed health insurance claims and correspondence relative to the third party and primary care provider programs. Prepares monthly, quarterly and annual reconciliation and recapitulation of third party billing to assure that collections, billed data and computerized and manual reports are in balance. Analyzes, maintains and directs the billing operation for third party program and acts as an advocate for IHS on the collection of alternate resources. Responds to third party requirements on post-payment reviews, exclusions, denials and appeals for Parker Service Unit. Performs daily in-patient interviews to obtain specific demographic and insurance information in a diplomatic and confidential manner, upon admission to the IHS facility.