Summary This position is located in the Third Party Billing Section of the CRSU, Patient Business Office, in Parker, Arizona. This position is under the Supervision of the Financial Manager. The primary function of this position is to manage department with responsibility, accountability, direct and coordinate 3rd party resources. Responsibilities Serves as the primary Insurance Credentialing for PBO. Ensures all applications to Medicare, Medicaid and any Private Insurance companies are completed to specifications. Maintains Medicare, Medical and private/commercial insurance manuals and directives, Providers Reimbursement Manual, Direct Dealings, Provider Letters, and Federal Health Insurance for the aged, Transmittals of bills, vouchers and schedules and any addendums to the ICD-9-CM Coding volumes. Supervises the filing of all pending and completed health insurance claims and correspondence relative to the third party and primary care provider programs. Prepares monthly, quarterly and annual reconciliation and recapitulation of third party billing to assure that collections, billed data and computerized and manual reports are in balance. Analyzes, maintains and directs the billing operation for third party program and acts as an advocate for IHS on the collection of alternate resources. Responds to third party requirements on post-payment reviews, exclusions, denials and appeals for Parker Service Unit. Performs daily in-patient interviews to obtain specific demographic and insurance information in a diplomatic and confidential manner, upon admission to the IHS facility. Requirements Conditions of Employment Must pass pre-employment examination. Selectee may be subject to a probationary period ESEP appointees typically serve a two year probationary 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. A one-year supervisory/managerial probationary period may be required upon selection/placement. 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. BASIC REQUIREMENT(S): Individual Occupational Requirements Undergraduate and Graduate Education Major study-- hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. OR Specialized Experience: Progressively responsible analytical or administrative, or clinical management or supervisory experience in the health care field. This work may have been performed in an operating health care facility or a higher organizational echelon with advisory or directional authority over such facilities. Work must have involved a close working relationship with facility managers and analysis and/or coordination of administrative, clinical, or other service activities, and provided knowledge of the following: Missions, organizations, programs, and requirements of health care delivery systems; Regulations and standards of various regulatory and credentialing groups; and Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement. MINIMUM QUALIFICATIONS, GS-0671-12: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the 11 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Provides or assisted with providing management oversight and accountability for administrative and management services related to Business Office, Purchased Referred Care, Health Information Management and/or IT. Follows established policies and procedures of a Business Office, Purchased Referred Care, Health Information Management and/or IT, determines if program is functioning efficient and effectively to meet established requirements. 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 an education requirement. You are strongly encouraged to submit a copy of your transcripts or a list of your courses including titles, credit hours completed, and grades. Unofficial transcripts will be accepted in the application package. Official transcripts will be required from all selectees prior to receiving an official offer. Only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education may be credited. Applicants can verify accreditation at the following website: https://www.ed.gov/accreditation. 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 may be authorized. At least a 1 year service agreement will be required. This position meets the criteria specified in pillar number one of the five pillars of the PHS Commissioned Corps. PHS Commissioned Officers interested in performing the duties of this position within the Commissioned Corps MUST apply online under the merit promotion announcement indicated above in order to receive consideration. For more information on PHS Commissioned Corps, visit the website at: https://www.usphs.gov/. This position has no promotion potential.