Experience Inc. Jobs

Summary This position is located at the Whiteriver Service Unit, Purchased Referred Care (PRC), Phoenix Area Indian Health Service. The purpose of this position is to provide technical and administrative assistance in the management and administration of the Purchased Referred Care (PRC) Program. This position will report to the Supervisory Health System Specialist or Designee, on-site. Responsibilities Determine eligibility of patients for PRC and prepare authorization or denial documents based on applicable PRC regulations, policies and practices. Prepare referrals with correct patient information, medical report and calculated estimates charges of medical care and equipment for review by Purchased Referred Care Committee. Functions in a liaison capacity to both vendors and recipients of PRC by telephone and through written correspondence. Screens verifies and determines all Purchased Referred Care notifications, claims, statement of private vendors, emergency room notes and patient discharge summaries. Explains and interprets regulations and policies to health service providers and recipients as well as IHS personnel. Ensures and maintains internal fiscal controls; and billing and collection procedures on funds being obligated or collected. This position is being re-advertised to solicit additional applications. Applicants who applied previously need not reapply unless submitting updated and/or missing information. 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. Confidential Financial Disclosure Form required. 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. 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, GS-06: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-05 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Examples include: apply patient referred/care procedures and regulations, work with funding limitations and policies, technical, administrative and clerical functions related to the patient referral program; proper processing requirements including forms, authorization documents, correspondence and reports; Maintain obligation registers regarding funds for medical services. MINIMUM QUALIFICATIONS, GS-07: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-06 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Examples include: Apply policies, procedures, rules and regulations when determining patient eligibility, availability of services and identification of fiscal resources; Manage funds control techniques to account for allotted funds and preparing statements and reports; operate an automated data program system for patient referral reporting, funds control techniques. 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 Additional Information 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. The Indian Health Service (IHS), National Health Service Corps (NHSC), and the Health Resources and Services Administration (HRSA) have student loan repayment programs for qualifying health disciplines. This is a competitive process separate from the hiring process. Opportunities for LRP are based on agency hiring priorities and availability of funds. For additional information please visit: For IHS - http://www.ihs.gov/loanrepayment/ For NHSC - https://nhsc.hrsa.gov/loanrepayment/ For HRSA Nurse Corps - https://bhw.hrsa.gov/loansscholarships/nursecorps 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. This position is being re-advertised to solicit additional applications. Applicants who applied previously need not reapply unless submitting updated and/or missing information.