Experience Inc. Jobs

Summary This position is organizationally located in the Purchased Referred Care (PRC) Branch of the Cass Lake Indian Hospital. The function of the PRC Branch is to manage a Purchased Referred Care Delivery System. The purpose of this position is to provide support and technical assistance to specialists in the provision of PRC to Indian beneficiaries. This position is located in Cass Lake, Minnesota in the Bemidji area. Responsibilities Initiates and distributes medical authorizations including both hospitalizations and professional fees after determining patient eligibility for Purchased Referred Care (PRC). Assure adequate funds are set aside for all authorized referrals, emergency call-ins and follow up care referrals. Responsible for keeping up-to-date pending and completed PRC patient files, with documented status of all written and verbal transactions. Maintains denial correspondence files including supporting documentation and insures that reconsideration requests are made available to the appropriate supervisor in a timely manner. Incumbent must have knowledge of computer applications relating to PRC program, including the responsibility for entering and verifying all PRC authorizations, payments, cancellations and supplements. Requirements Conditions of Employment Must pass pre-employment examination. 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 This is a designated position covered by Public Law 101-630, requiring contact or control over Indian children. Due to this requirement, the agency must ensure that persons hired for these positions have not been found guilty of or pleaded nolo contendere or guilty to certain crimes. Measles and Rubella immunization required for selectees born after 1957 and seasonal influenza immunization is required for all staff working in Indian Health Service health care facilities. COVID-19 vaccination is required for all selectees prior to entrance on duty. 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. 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: Minimum Qualifications for GS-04: 1 Year of General Experience OR 2 Years of Education above the High School level. General Experience is defined as progressively responsible clerical, office, or other work that indicates ability to acquire the particular knowledge and skills needed to perform the duties of the position to be filled. Minimum Qualifications for GS-05: 1 Year of Specialized Experience equivalent to at least the GS-04 Grade Level OR 4 Years of Education above the High School level. Specialized Experience is defined as 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. Examples include: Responding to inquiries and requests through telephone, correspondence and personal visits. Experience in funds control techniques and monitoring and accounting for funds allotted. Minimum Qualifications for GS-06: 1 Year of Specialized Experience equivalent to at least the GS-05 Grade Level. Examples include: Assuring funds have been obligated within deadlines, unused obligations are cancelled and re-obligated. Assisting in determining patient eligibility. Maintaining obligation registers regarding funds for inpatient and outpatient services. Minimum Qualifications for GS-07: 1 Year of Specialized Experience equivalent to at least the GS-06 Grade Level. Examples include: Experience in applying policies, procedures, rules and regulations when determining patient eligibility, availability of services and identification of fiscal resources. Managing funds control techniques to account for allotted funds and preparing statements and reports. 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 This position has an education requirement. You are strongly encouraged to submit a copy of your transcripts or a list of your courses including titles, credit hours completed, and grades. Unofficial transcripts will be accepted in the application package. Official transcripts will be required from all selectees prior to receiving an official offer. Only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education may be credited. Applicants can verify accreditation at the following website: https://www.ed.gov/accreditation. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit https://sites.ed.gov/international/recognition-of-foreign-qualifications/. Additional Information Per IHS policy (SGM 21-04) IHS selectees to positions located in Federally operated hospitals, health centers, and clinics must be fully vaccinated for COVID-19 before entry on duty or have IHS approve a medical or religious exemption. If an exemption is approved then wearing a face mask and regular testing for COVID-19 will be required. Your Human Resources Specialist will provide a list of documents acceptable as vaccination proof and instructions on how to submit your vaccination documentation or how to request a medical or religious exemption, if needed. Additional selection(s) of candidates may be possible within 240 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. Recruitment or relocation incentives may be authorized. At least a 6 month service agreement will be required. This position has promotion potential to the GS-07 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.