This position is located at the Northern Cheyenne Service Unit, Division of Administration and Management, Business Office Branch. The primary purpose of this position is the overall responsibility for a major segment of the accounts receivable management function. This responsibility includes the submission of properly executed claims on a timely basis to third party payers and responsible parties and rebilling or corrected billing of accounts previously submitted.
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. 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: searching and retrieving individual patient record(s) to gather and compile information for billing for outpatient services and inpatient hospitalization; maintaining files on pending and completed claims; performing daily interviews to obtain specific demographic and insurance information; preparing authorization for release of medical information, assignment of benefits, and other authorization for obtaining prior approval and pre-certification; responding to inquiries and requests for information; 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: billing the applicable agency for services provided to a patient; responding to third party requirements on post-payment reviews, exclusions, denials, and appeals; provides orientation and training to appropriate personnel; verifying that medical records contain proper documentation in accordance with regulations; monitoring inpatient daily census on a concurrent basis. 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.
Claims Processing - responsible for billing the appropriate agency for services provided utilizing the automated third party billing procedures. Reviews clinical management of patient condition to ensure proper levels of care are noted. Accounts Receivable-maintains A/R system pertaining to posting activities, account aging status and follow-up activities. Denials - follows up on claim denials, ensures investigation activities are documented.