Summary This position is located in the Purchased Referred Care Department at Shiprock Service Unit, Shiprock, NM. The purpose of the position is to administer the provision of Purchased Referred care in compliance with regulatory requirements. Employee identifies and assists patients who may be eligible for coverage by third party resources. Responsibilities Receives notification and referrals for non-IHS and IHS referred care through hard copy or the automated referred care system Verifies and determines patient's eligibility for Medicare, Medicaid, Private Insurance, VA or other potential alternate resources Researches matters thoroughly based on appropriate regulations or other mandatories prior to rendering work product Prepares memoranda for correspondence for the reviewing appeals officer, identifies deficiencies and recommends appropriate course of action Performs prescreening process for potential eligibility and gathers pertinent information utilized to determine PRC eligibility and potentially eligibility for alternative resources Conducts in-depth face-to-face interview or by telephone with patients and/or families to ensure accurate completion of enrollment application Ensures that PRC funds are available prior to issuance of obligating documents on behalf of the government Initiates medical authorizations and denial of service for inpatient/outpatient/ancillary medical services for eligible IHS beneficiaries Maintains complete fund control records for health services funds allotted Issues correspondence to patients, health care providers and other agencies Assures request for contracts are submitted with work specifications Tracks all referrals to non-IHS facilities to include those referrals to other IHS facilities to support Case Management activities Requirements Conditions of Employment Selectee may be subject to a probationary/trial period ESEP appointees typically serve a two year trial period U.S. Citizenship is required Selective Service Registration is required for males born after 12/31/1959 Confidential Financial Disclosure Form required. Measles and Rubella immunization required for selectees born after 1957. Seasonal Influenza immunization is required for civilian health care facility staff working in Indian Health Service health care facilities. Successfully pass the E-Verify employment verification check. To learn more about E-Verify, including your rights and responsibilities, visit www.dhs.gov/E-Verify/. You will need to set up direct deposit so we can pay you. Background Investigation: If you are selected for this vacancy, you must undergo a pre-employment fingerprint check and background investigation. Fingerprint results and background investigation documentation must be cleared prior to hire. After you begin your employment, your continued employment is contingent upon the outcome of a complete background investigation as determined by the sensitivity level of your position. The investigation must find that you are suitable for Federal employment in your position. If you are found not suitable, you will be terminated after you begin work. If you make a false statement in any part of your application, you may not be hired; you may be fired after you begin work; or subject to possible criminal charges. You may be subject to a credit check as a part of the background investigation process. Fingerprinting, as part of the background investigation process, may be delayed due to COVID-19. All other background investigation procedures will apply. Be advised that your continued employment will require you to complete a fingerprint check within 60 days after notification of return to full operations and successfully obtaining a favorable background investigation. Qualifications 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-06: One (1) year of specialized experience equivalent to the GS-05 grade level. GS-07: One (1) year of specialized experience equivalent to the GS-06 grade level. GS-08: One (1) year of specialized experience equivalent to the GS-07 grade level. Specialized Experience Experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform successfully the duties of the position, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level. Applicants who have the 1 year of appropriate specialized experience are not required by this standard to have general experience, education above the high school level, or any additional specialized experience to meet the minimum qualification requirements. 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: Specialized experience at the GS-06 Level I have 1 year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-05 level in the Federal service as described in the vacancy announcement. Examples include: Retrieve, organize, and prepare medical records upon request. Scan documents. File reports and other pertinent information into the paper record in accordance with regulations. Perform routine clerical duties. Specialized experience at the GS-07 Level I have 1 year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-06 level in the Federal service as described in the vacancy announcement. Examples include: Knowledge in policy and regulations related to medical records confidentiality. Analyze and code medical records in automated record systems. File and purge inactive charts. Interact with personnel for corrective coding and data entry. Specialized experience at the GS-08 Level I have 1 year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-07 level in the Federal service as described in the vacancy announcement. Examples include: Provide information or rights and benefits of multiple alternate resources and advise patients of nonpayment or approval of claim. 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. Education There are no education requirements. Additional Information Additional selection(s) of candidates may be possible within 90 days from the date the certificate of eligibles was issued for this announcement. Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. IHS may offer newly-appointed Federal employees credit for their directly related previous non-federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which they earn annual leave. This position is covered by a Bargaining Unit. This position has promotion potential to the GS-08 grade level. Promotion to the next grade level is at management's discretion and is based on your demonstrated ability to perform the higher level duties, the continuing need for the higher level duties, and "Regulatory/Administrative" approval. Promotion to the next higher grade level is not guaranteed and no promise of promotion is implied.