Contact Representative (Benefits)

Full Job Description

Join the Indian Health Service as a Contact Representative (Benefits) and make an impact.

The role involves identifying patients eligible for alternate resources, assisting with enrollment, advocating on their behalf, and acting as a liaison between the IHS work unit and non-IHS providers and facilities.

USAJOBS Help Center - Update your resume now so it meets new resume requirements 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-07: One (1) year of specialized experience equivalent to the GS-06 grade level.

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: Knowledge of, and ability to apply a multitude of Alternate Resource regulations, knowledge of medical terminology, ability to act as an advocate for patients, ability to maintain effective work relationships with patients, co-workers, and community, knowledge of Privacy Act and HIPAA, use of confidential information and health records, and maintaining confidential patient information.

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 cut-off day of rating to be eligible for consideration. Major Duties:

There MAY NOT be immediate vacancies at all locations. Verifies and determines patient's eligibility for Medicare, Medicaid, Private Insurance, VA or other potential alternate resources.

Provides information on rights and benefits of multiple alternate resources and advises patient of nonpayment or denial of claims.

Identifies and follows up on pending applications and timely entry of all third party resources.

Conducts face-to-face interviews or by telephone with patients and/or families to ensure accurate and complete enrollment application.

Obtains copies of verification of household income or other source of documentation, requests all other income from beneficiary and household members.

Initiates medical authorizations and denial of service for inpatient/outpatient/ancillary medical services for eligible IHS beneficiaries. Investigates and analyzes controversial issues.

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 IHS 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.

Participates in the weekly Case Management meetings, takes minutes and prepares the minutes for record and reporting purpose.