At the Indian Health Service, Contact Representatives in Purchased Referred Care ensure patients receive timely access to medically necessary services. They determine eligibility, coordinate alternate resources, and safeguard limited healthcare funds while upholding federal regulations. You play a vital role in connecting American Indian and Alaska Native patients to care. USAJOBS Help Center - Update your resume now so it meets new resume requirements
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: GS-08: 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: Experience interpreting and applying complex federal, state, or private sector regulations for programs such as Purchased Referred Care, Medicare, Medicaid, Veterans Affairs healthcare, Affordable Care Act plans, or similar benefit systems. Experience analyzing medical, financial, and eligibility documentation on a case-by-case basis, conducting in-depth interviews, and resolving complex or controversial benefit issues. Experience ensuring fiscal accountability of obligated funds, coordinating with multiple agencies or providers, and exercising independent judgment in making final eligibility and funding determinations. 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 by the respective cut-off day of rating to be eligible for consideration.
Serves as a Contact Representative in Purchased Referred Care administering eligibility determinations in accordance with federal regulations and IHS policy. Conducts detailed interviews with patients and families to verify eligibility for PRC and alternate resources such as Medicare, Medicaid, VA, and private insurance. Issues medical authorizations or denial letters, ensures funds availability prior to obligation, and maintains fiscal controls in compliance with federal requirements. Researches complex cases, interprets regulations, prepares reports, and serves as liaison with providers, tribal entities, and federal, state, and local agencies to ensure continuity of care and appropriate use of funds.