Summary This position is located in the Business Office of the Rosebud IHS Service Unit in Rosebud, South Dakota. The functions of this position will include; 1) Prior Authorizations/Pre-Certifications; 2) Provider Enrollment; 3) Appeals; and 4) Accounts Receivable. Responsibilities Works closely with the inpatient, surgery, outpatient, ancillary and various staff and third-party payers to obtain authorizations for services being rendered. Develops and maintains a system for monitoring services that require authorizations and to ensure the authorizations are completed in a timely and efficient manner. Works closely with credentialing, Staff Development Specialist, and Nurse Educator to enroll nursing and providers with South Dakota Medicaid, Medicare and Private Insurance Maintains a detailed tracking system for provider enrollment and gives weekly updates to supervisor. Works closely with Accounts Receivable and denials management. Requirements Conditions of Employment 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. Adherence to the IHS Employee Immunization Policy, SGM 21-04, and the IHS Circular 2016-04 requiring Measles and Rubella, COVID-19, and seasonal influenza immunizations for staff working in Indian Health Service health care facilities OR an exemption request will need to be submitted. Housing may be available. 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. 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. In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. MINIMUM QUALIFICATIONS: GS-09: One (1) year of specialized experience equivalent to at least the GS-7 grade level AND/OR Master's or equivalent graduate degree OR two (2) full years of progressively higher level graduate education leading to such a degree OR LL.B. or J.D., if related 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: Examples of Specialized Experience: Direct the activities of the Accounts Receivable and/or Denial/Accounts Management functions, perform long and short range planning, evaluation, and analysis; and projection of future resource requirements, personnel administration, provide training, development, and orientation of new and existing employees, and continuous quality improvement; Perform a variety of accounts receivable and denial/accounts management functions such as: examination, verification and maintenance of data involved in processing payments, denials and partial payments from alternate resources; determine the eligibility of patients; Identify and analyze issues, problems and challenges facing the revenue cycle management; Evaluate and compile data of denied claims and analyzes status reports for review to Management. NOTE: Equivalent combinations of education and experience are qualifying for all grade levels for which both education and experience are acceptable. 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 This position is eligible for workplace flexibilities which may include telework options, and/or flexible work scheduling. These flexibilities may be requested in accordance with the HHS Workplace Flexibilities policy. https://www.hhs.gov/about/agencies/asa/ohr/hr-library/990-1/index.html. Additional selection(s) of candidates may be possible within 240 days from the date the certificate of eligibles was issued for this announcement. This position is covered by a Bargaining Unit. Recruitment or relocation incentives may be authorized. At least a 6 month 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/.