Contact Representative (PRC)

• Apply and interpret federal state Tribal and private-sector regulations to determine patient eligibility and funding for healthcare programs.
• Analyze medical financial and eligibility documentation to resolve complex benefit authorization and coverage issues.
• Issue medical authorizations or denial determinations and coordinate with patients providers and agencies to support continuity of care.
• Maintain fund control records monitor expenditures apply accounting codes and resolve program or funding discrepancies.
• Compile and analyze reports related to program operations funding and utilization.

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: identifying and verifying patient eligibility for Medicare Medicaid SSA benefits private insurance Tribal programs and other assistance resources; interviewing patients to obtain required documentation; assisting individuals and families with benefit applications; reviewing records to determine the status of claims and applications; responding to inquiries regarding patient eligibility requirements benefits and program guidelines; and maintaining accurate patient records through data entry discrepancy resolution and follow-up on pending claims and missing documentation.

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: determining patient eligibility and preparing or issuing medical authorizations and denial determinations in accordance with established regulations and program requirements; identifying and verifying alternate resource coverage including Medicare Medicaid VA benefits and private insurance; researching and resolving discrepancies related to eligibility claims medical authorizations coverage and supporting documentation; coordinating referrals and follow-up with healthcare facilities to support continuity of care; and responding to inquiries from patients providers and agencies regarding eligibility claims and program requirements.

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: applying and interpreting complex federal state Tribal and private-sector regulations to make eligibility and funding determinations for programs such as Purchased/Referred Care Medicare Medicaid Veterans Affairs healthcare and Affordable Care Act plans; independently analyzing medical financial and eligibility documentation to resolve complex or controversial benefit issues; coordinating with agencies providers and patients to ensure fiscal accountability and continuity of care; issuing medical authorizations or denial determinations based on regulatory clinical and fiscal requirements; maintaining fund control records monitoring expenditures and applying appropriate accounting codes; identifying and resolving program or funding discrepancies; and compiling and analyzing reports related to program operations funding and utilization.

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 cutoff day of rating to be eligible for referral.