Contact Representative (PRC)

Indian Health Service • Manlius, NY

6d

About The Position

The Indian Health Service is hiring a Contact Representative to support access to healthcare services for American Indian communities. The role assists patients with eligibility, medical authorizations, referrals, and healthcare benefits, while supporting healthcare administration and continuity of care.

The Contact Representative applies and interprets federal, state, Tribal, and private-sector regulations to determine patient eligibility and program funding. The role analyzes medical, financial, and eligibility documentation; resolves benefit, authorization, and coverage issues; issues medical authorizations or denial determinations; and coordinates with patients, providers, and agencies. It also maintains fund control records, monitors expenditures, applies accounting codes, resolves program or funding discrepancies, and compiles and analyzes reports on program operations, funding, and utilization.

The position has promotion potential to GS-08. Promotion is not guaranteed and is subject to management discretion and the stated performance, program, and approval conditions.

Requirements

• U.S. citizenship is required.
• Selective Service registration is required for males born after 12/31/1959.
• Successfully pass the E-Verify employment verification check.
• Set up direct deposit for payment.
• Successfully complete a federal background investigation as a condition of employment; required forms must be completed within five calendar days after instructions are received.
• Meet the applicable specialized-experience qualification for the grade sought: GS-06 requires at least one year equivalent to GS-05; GS-07 requires at least one year equivalent to GS-06; GS-08 requires at least one year equivalent to GS-07.
• Meet all qualification requirements within 30 days of the announcement closing date.
• For GS-06, demonstrate specialized experience with patient eligibility verification, patient interviews and documentation, benefit applications, claim and application status reviews, responding to eligibility and benefit inquiries, and maintaining accurate records through data entry, discrepancy resolution, and follow-up.
• For GS-07, demonstrate specialized experience determining patient eligibility and preparing or issuing medical authorizations and denials; verifying alternate coverage; resolving eligibility, claim, authorization, coverage, and documentation discrepancies; coordinating referrals and follow-up; and responding to inquiries from patients, providers, and agencies.
• For GS-08, demonstrate specialized experience interpreting complex regulations for eligibility and funding determinations; independently analyzing documentation to resolve complex benefit issues; coordinating for fiscal accountability and continuity of care; issuing authorizations or denials; maintaining fund control records and monitoring expenditures; applying accounting codes; resolving funding discrepancies; and analyzing program, funding, and utilization reports.
• Comply with the IHS Employee Immunization Policy if duties require working permanently, temporarily, or occasionally in an IHS healthcare facility; vaccine exemption requests may be available under policy and facility guidance.
• Because the position involves contact or control over Indian children, meet the suitability requirements concerning certain criminal convictions or pleas under Public Law 101-630.
• A service agreement of at least six months is required.

Responsibilities

• Apply and interpret federal, state, Tribal, and private-sector regulations to determine patient eligibility and healthcare program funding.
• Analyze medical, financial, and eligibility documentation to resolve 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.

Benefits

• Federal employee benefits package for eligible employees and their families.
• Annual leave accrual based on years of federal service, at a rate of 4, 6, or 8 hours per pay period.
• IHS may offer newly appointed federal employees credit for directly related prior non-federal experience or active-duty uniformed military service when determining annual leave accrual.
• Recruitment or relocation incentives may be authorized.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed