ORGANIZATION LOCATION: Phoenix Indian Medical Center, Division of Financial Services, Patient Business Services. Position is located in Phoenix, AZ, and supervised through the Supervisory Health System Specialist. This position is responsible for completing enrollment and revalidation requests for CMS, state Medicaid programs, and private insurance entities. This position ensures account information is maintained and updated for credentialing, insurance and billing purposes.
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):INDIVIUAL OCCUPATIONAL REQUIREMENTS: Education: Undergraduate or graduate education with a major study in hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration; OR 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; OR 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. Special Provision for In-service Placement: Successful complete of an agency-sponsored on-the-job training program may be substituted for qualifying experience, provided it included a formal individualized training plan. Such a training program must have been conducted in an operating health care system and included: Assignments providing a knowledge of basic health system administration philosophies, practices, and procedures, and basic government administrative policies and requirements; Practical assignments providing an opportunity to apply health system administration skills and principles (as the individual progresses, work assignments must be characteristic of the grade level to which he or she is assigned); and Oversight by an experienced health system administrator with periodic evaluation of the individual's progress and appropriate adjustment of the training program. In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. MINIMUM QUALIFICATIONS - GS-09: 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: Experience within the medical billing department, revenue department, and/or provider enrollment department who is responsible for the evaluation and reporting and performs liaison functions with revenue team, providers, state Medicaid, CMS, and private insurance entities; Served as a facility or provider authorized organizational official to review and complete CMS, state Medicaid, private insurance, and managed care applications; Assists and supports medical staff to complete state Medicaid attestation and registration process; Analyzes and evaluates (on a quantitative or qualitative basis) the effectiveness of program operations; OR Master's or equivalent doctoral degree; OR Two (2) full years of progressively higher level graduate education leading to such a degree; OR LL.M., if related that included major study in hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration; OR Combination of education and specialized experience: Possess a combination of experience AND graduate education that when combined fully meet the minimum qualifications for this position. The total percentage equals at least 100% for qualification requirements of this position. 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.
Performs provider and facility registration duties such as, coordinating internal review systems to ensure compliance with agency, accrediting and certifications, manages provider enrollments or facility applications, maintains provider and facility enrollment information for billing purposes, provide routine reporting for compliance and internal audit processes. Performs performance reporting duties such as, serving as an authorized official on behalf of providers or facility to manage various enrollments, assist medical staff to complete state Medicaid attestation and registration process, assist with providers or facility with maintaining various information systems, assists with organizing and maintaining attestation documents and reports for audit purposes. Perform health system specialist duties such as analyze and evaluate effectiveness of program operations for provider enrollment, reporting requirements, various information systems, analyze and implement regulations or processes to determine impact on program operations, conducts assessments to determine compliance or determine corrective actions. Total Compensation Package - Check out IHS's outstanding total compensation package for this job: Health System Specialist Total Compensation | Pay (ihs.gov)