Contact Representative (Benefits Coordinator)

• Assists patients in identifying and obtaining alternate health care resources including Medicare Medicaid VA Tribal and other third-party programs.
• Conducts patient interviews to gather information for eligibility determinations and enrollment.
• Assists with completing applications verifying eligibility and maintaining enrollment records.
• Provides information regarding benefits coverage program requirements and available resources.
• Coordinates with patients families healthcare staff and external agencies to obtain required information and facilitate referrals.
• Follows up on pending applications enrollments and claims to support timely processing.
• Assists in resolving eligibility coverage and reimbursement issues in accordance with established policies and procedures.
• Maintains confidential patient information and records in compliance with Privacy Act and HIPAA requirements.
• Utilizes automated systems to document track and report eligibility and enrollment activities.
• Supports patient access to healthcare services through effective customer service and application of alternate resource program requirements.

Selectee may be subject to a probationary 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.

Successfully pass the E-Verify employment verification check. To learn more about E-Verify including your rights and responsibilities visit must maintain an active bank account with a financial institution to receive salary payments through electronic direct deposit.

Background Investigation Requirement:

This position requires the successful completion of a federal background investigation as a condition of employment.

A background investigation is a standard process used by the Federal Government to verify an individuals identity employment history education and other relevant information to determine suitability for Federal service.

Upon receipt of instructions applicants must complete all required background investigation forms within five (5) calendar days of issuance. Timely completion is critical to avoid delays in processing or a determination of unsuitability.

Applicants are strongly encouraged to prioritize this requirement and to maintain regular communication with their assigned Personnel Security Specialist throughout the process.

Financial Suitability Requirement:

This position requires a review of the applicants financial history as part of the personnel security and suitability determination. Applicants must demonstrate financial responsibility maintain good standing with creditors and satisfy all legal financial obligations prior to applying.

Individuals with substantial delinquent or unresolved financial obligations-including but not limited to delinquent federal or state tax liabilities defaulted federal student loans court-ordered fines or fees or child support arrears-may be deemed unsuitable for employment with the Indian Health Service (IHS).

Prior to the appointment candidates must present two valid forms of identification. If one of the documents is a state-issued ID or drivers license it must be REAL ID-compliant.

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: determining patient eligibility for alternate resources programs; interpreting and applying Medicare Medicaid VA and other third-party payer policies and procedures; conducting patient interviews to identify available healthcare coverage and funding sources; assisting patients with enrollment and claims processes; researching and resolving eligibility denial and reimbursement issues; maintaining effective working relationships with patients and resource agencies; and safeguarding confidential patient information in accordance with Privacy Act and HIPAA requirements.

GS-07: 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: assisting patients with alternate resources and eligibility processes; conducting patient interviews to obtain information for program eligibility and enrollment; providing information on Medicare Medicaid Tribal and other healthcare programs; reviewing applications and supporting documentation for completeness; coordinating with patients and outside agencies to obtain required information; maintaining confidential patient records; and applying established policies procedures and guidelines in a healthcare setting.

GS-08: 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: interpreting and applying federal state Tribal and third-party program regulations to determine eligibility and ensure compliance for programs such as Purchase Referred Care Medicare Medicaid Affordable Care Act Veterans Affairs Healthcare and other alternate resources; conducting in-depth patient interviews to assess eligibility verify coverage and complete applications; registering eligible patients in various assistance programs; resolving claim denials and eligibility issues through coordination with patients healthcare providers and outside agencies; reviewing Medicaid eligibility information and supporting billing requirements; and utilizing effective oral and written communication to explain program requirements provide referrals and resolve complex patient service issues.

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.