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Summary These 3 vacancies are located at the Colorado River Service Unit (CRSU). Peach Springs Health Clinic in Peach Springs, AZ or at the Southern Bands Health Clinic located in Elko, NV. This position provides Lead support for the Patient Business Office (PBO) Department or the Purchased Referred Care (PRC) department. The incumbent is part of a team that is responsible for proving medical support assistance to the PBO/PRC team for the assigned department. Responsibilities Total Compensation Package - Check out IHS's outstanding total compensation package for this job: Medical Support Assistant Total Compensation | Pay (ihs.gov) Lead Duties: Serves as work leader, responsible for substantially assuring that the work assignments of other employees of the group are carried out. Typical duties include, but are limited to: Distributes and balances the workload amount employees in accordance with established workflow or job specialization, assures timely accomplishment of the assigned workload, and assures that each employee has enough work to keep busy with adequate working conditions. Keeps in touch with the status and progress of work, and makes day-to-day adjustments in accordance with established priorities, obtaining assistance from the supervisor on problems that may arise, such as backlogs, which cannot be disposed of promptly. Instructs employees in specific tasks and job techniques and makes available written instruction, reference materials, and supplies. Gives on-the-job training to new employees in accordance with established procedures and practices; approves leave for few hours for emergencies. Accounts Receivable Leads a team in provide medical support assistance for the Service Unit by providing medical posting and batching payments received on a daily basis. Also follows-up on non-payments, adjustments and refunds to ensure staff are following established guidelines. Accesses appropriate data after preparing a logical search strategy and structuring the requirement and acceptable identifiers. Reviews incoming correspondence determining whether the claim is final; or more medical information is needed; or claim needs to be resubmitted; or appropriate biller, as needed and/or posted as a true denial. Notifies the insurance carrier within the timeframes required. Denial Management (Billing) Serves as contact person in providing medical support assistance relative to any questions or problems with denial management (billing). Such contacts involve a variety of program related matters, interpretation of regulatory material and determining the applicability of guidelines and instructions to problems or situations that, in many instances, are not specifically covered. Makes recommendations for changes in methods and procedures, information dissemination and other denial management to resolve recurring problems and expedite processing actions. Responds to third party requirements on post-payment reviews, exclusions, denials and appeals. Actively performs audits and medical reviews to ensure documentation and accountability of all health insurance claims submitted for payment by conducting random sample reviews. PRC (Purchase Referred Care) Medical Support Duties: Oversees and coordinates the daily operational functions of the service unit's Purchase Referred Care Health Services Program in providing medical support assistance. Acts as patient advocate to resolve payment questions and payer responsibilities to vendors and providers of contracted and/or non-purchase referred care health care services. Acts as liaison for the service unit to vendors, providers, other IHS agencies and outside agencies to maintain a positive working relationship with all agencies; to improve and to maintain positive communications and to provide guidance to outside agencies on IHS policies and procedures. Responsible for the Purchase Referred Care Health Services Quality Assurance Program. 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. IHS Selectees that will work in an IHS health care facility may be subject to Employee Health Policies related to Measles and Rubella, COVID-19, and seasonal influenza immunizations. Vaccine exemption requests may be available according to the National and/or Service Unit guidance. 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. GS-08: MINIMUM QUALIFICATIONS: 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: LEAD experience examples include: Served as a work leader, distributed and balanced a workload, coordinate and manage employee workloads, provide reporting and status on departmental operations, provides instructions and resources for employes to accomplish assigned tasks, provide on the job training, coordinate or oversee a leave calendar. PURCHASED REFERRED CARE experience examples include: Applying rules and procedures and regulations under the Purchased Referred Care (PRC) program; implementing PRC budget funding limitations; advising others of procedural and regulatory requirements; and assisting in the management of PRC transactions while submitting authorizations through proper channels. PATIENT BUSINESS OFFICE experience examples include: Experience working in accounts receivable providing medical posting and batching payments, follow up on non-payments, Reviews incoming correspondence determining whether the claim is final; or more medical information is needed; or claim needs to be resubmitted; or appropriate biller, as needed and/or posted as a true denial. Communicates directly with third party payers on the eligibility of patients, Prepares final data for submission to Treasury for collections for the Third-Party Billing department. Denial Managment experience, Serves as contact person in providing medical support assistance relative to any questions or problems with denial management (billing), Responds to third party requirements on post-payment reviews, exclusions, denials and appeals, Responsible for reviewing claim upon receiving, until claim has been paid by Third Party Payer. 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 This position has no education requirements. 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. Recruitment and/or Relocation Incentives and/or PCS may be authorized and is subject to availability and service unit approval. If offered, you will be required to sign a one (1) year service agreement. Failure to fulfill the service agreement will result in repayment of the incentive. This position has no promotion potential.