Contact Representative
Receives notification and referrals for non-IHS and IHS referred care through hard copy or the automated referred care system (electronic Health Records (EHR) - Referred Care Information System (RCIS) tab). Verifies and determines patient's eligibility for Medicare, Medicaid, Private Insurance, VA or other potential alternate resources as appropriate, which are available and accessible to the individual. Performs pre-screening process for potential eligibility and gathers pertinent information utilized to determine PRC eligibility and potentially for alternate resources. Gathers all demographic and third party information from the patient or family and verifies against existing patient registration information or gather all pertinent information (demographic/third party) to establish a new medical record chart. Ensures that PRC funds are available prior to issuance of obligating documents on behalf of the government. Maintains complete fund control records for health services funds allotted. Issues correspondence to patients, health care providers and other agencies regarding eligibility, IHS policy and regulations, including letters of denial of payment where the requirements of the PRC program are not met. Tracks all referrals to non-IHS facilities to include those referrals to other IHS facilities to support the Case Management activities and continuity of care efforts. 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. For positions requiring positive education requirements, or if you are using education to meet all or part of the qualification requirements, you MUST submit a copy of your transcripts or an itemized list of college courses which includes equivalent information from the transcript (course title, semester/quarter hours, and grade/degree earned) in your resume. MINIMUM
Qualifications:
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. GS-6:
One year of specialized experience equivalent to the GS-5 grade level to qualify for the GS-6 level. GS-7:
One year of specialized experience equivalent to the GS-6 grade level to qualify for the GS-7 level. GS-8:
One year of specialized experience equivalent to the GS-7 grade level to qualify for the GS-8 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. Example of qualifying specialized experience for the GS-6:
Skilled in conducting patient interviews; experience with assisting patients with completing forms for alternate resources; ability to interpret rules and regulations; ability to identify and assist patients with eligibility coverage and third party resources, determine patient's eligibility for Medicare, Medicaid, Private Insurance, Veteran's Administration, etc. Perform issuance of documents ie. medical authorizations; maintain fund control records and ability to track referrals. Example of qualifying specialized experience for the GS-7:
Receives notifications and referrals for health care facility, verifies and determines eligibility for coverage; extracts statistical data to prepare and submit reports; ability to forecast weekly control registers and obligations; review incoming claims for determinations, explain and interpret regulations and policies to patients and providers; maintain appeal records for appeal process; perform case by case interviews, data gathering and ability to research to determine approval/denial of cases. Monitor activities and records pertaining to fiscal management of funds, tracks referrals for case management purposes. Experience in medical terminology and basic human anatomy. Example of qualifying specialized experience for the GS-8:
Ability to define and interpret regulations and guidelines for a direct care health service. Ability to govern administration and apply program rules; provides expertise for Medicare, Medicaid, Social Security Administration, Tribal Programs, etc. eligibility requirements; ability to conduct extensive searches for information and reconstruction of cases; ability to adjudicate, analyze, provide advice on appeal cases, skilled in compiling and writing reports; ability to make decisions regarding authorized documents; skilled in fiscal coding procedures with accurate accountability of funds. You must meet all qualification requirements within 30 days of the closing date of the announcement. 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).
Estimated Salary: $20 to $28 per hour based on qualifications.
Qualifications:
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. GS-6:
One year of specialized experience equivalent to the GS-5 grade level to qualify for the GS-6 level. GS-7:
One year of specialized experience equivalent to the GS-6 grade level to qualify for the GS-7 level. GS-8:
One year of specialized experience equivalent to the GS-7 grade level to qualify for the GS-8 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. Example of qualifying specialized experience for the GS-6:
Skilled in conducting patient interviews; experience with assisting patients with completing forms for alternate resources; ability to interpret rules and regulations; ability to identify and assist patients with eligibility coverage and third party resources, determine patient's eligibility for Medicare, Medicaid, Private Insurance, Veteran's Administration, etc. Perform issuance of documents ie. medical authorizations; maintain fund control records and ability to track referrals. Example of qualifying specialized experience for the GS-7:
Receives notifications and referrals for health care facility, verifies and determines eligibility for coverage; extracts statistical data to prepare and submit reports; ability to forecast weekly control registers and obligations; review incoming claims for determinations, explain and interpret regulations and policies to patients and providers; maintain appeal records for appeal process; perform case by case interviews, data gathering and ability to research to determine approval/denial of cases. Monitor activities and records pertaining to fiscal management of funds, tracks referrals for case management purposes. Experience in medical terminology and basic human anatomy. Example of qualifying specialized experience for the GS-8:
Ability to define and interpret regulations and guidelines for a direct care health service. Ability to govern administration and apply program rules; provides expertise for Medicare, Medicaid, Social Security Administration, Tribal Programs, etc. eligibility requirements; ability to conduct extensive searches for information and reconstruction of cases; ability to adjudicate, analyze, provide advice on appeal cases, skilled in compiling and writing reports; ability to make decisions regarding authorized documents; skilled in fiscal coding procedures with accurate accountability of funds. You must meet all qualification requirements within 30 days of the closing date of the announcement. 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).
- Department:
0962 Contact Representative - Salary Range:
$39,166 to $62,661 per year
Estimated Salary: $20 to $28 per hour based on qualifications.
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