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Summary ORGANIZATION LOCATION: Indian Health Service (IHS), Phoenix Area Office, Phoenix Indian Medical Center - Purchase Referred Care Department, Phoenix Service Unit. Position is located in Phoenix, AZ., and supervised through Supervisory Health System Specialist. Incumbent identifies and assists patients who may be eligible for coverage by third party resources. Responsibilities Receives notification and referrals for non-IHS and IHS referred care through hard copy or the automated referred care system. Enters or edits all referrals. Ensures accurate data entry in order to retrieve meaningful reports. Prepares memoranda for correspondence for the reviewing appeals, identifies deficiencies and recommends appropriate course of action. Performs substantive research in the areas of medical documentation, administrative compliance, inquiries and reports of investigation and standards of conduct/ethics. Reviews completed documents for accurate patient information, clinical data, obligation signatures and fiscal data. Extracts statistical data from various software systems to prepare and submit reports. Answers telephone and personal inquiries regarding payment, patient admitted to non-IHS facilities, outstanding charges, eligibility, etc. Medical confidentiality must be maintained and adhered to. 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. Work Schedule: Monday thru Friday, 40 hours per week. 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. MINIMUM QUALIFICATIONS - GS-06: 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: Apply an extensive body of rules and procedures concerning benefits sufficient to clarify benefit processes and procedures to patients, conduct personal or telephone interview, search records or guidelines, provide full explanations in response to specific inquiries relating to the agency, resolve problems and issues, evaluate the extent of the customer's knowledge of the options and choices open to them, explain the requirements placed on them by laws and regulations, review records and contact other offices to learn status of pending actions, the reasons for delays or changes, and what action or additional information is required to resolve the case. MINIMUM QUALIFICATIONS - 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: In a Purchased Referred Care setting environment applied comprehensive rules, regulations, techniques and procedures sufficient to review the particular circumstances and goals of individuals in order to apply the combination of benefits, services or regulatory requirements that will best meet their needs over a span of time; advise individuals on all aspects of benefits and services that should be considered in deciding the most advantageous choice or action; demonstrate alternative formulas for computing benefits with offsetting advantages and disadvantages; compile and write reports and Alternate Resource needs. MINIMUM QUALIFICATIONS - 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: In a Purchased Referred Care setting environment performed applicable tasks, described in the GS-7, independently, interprets and follow established policies and procedures and in some instances determines appropriate method and approach without consultation with supervisor. 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 There are 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 or Relocation Incentives or Permanent Change of Station may be authorized and is subject to availability and service unit approval. If offered, you will be required to sign a service agreement. The service period may not be less than 6 months and may not exceed 4 years. Failure to fulfill the service agreement will result in repayment of the incentive. This position has promotion potential to the GS-08 grade level. Promotion to the next grade level is at management's discretion and is based on your demonstrated ability to perform the higher level duties, the continuing need for the higher level duties, and "Regulatory/Administrative" approval. Promotion to the next higher grade level is not guaranteed and no promise of promotion is implied.