Contact Representative (PRC)

Join the Indian Health Service as a Contact Representative and support access to healthcare services for American Indian communities. Assist patients with eligibility, medical authorizations, referrals, and healthcare benefits while building a rewarding career in public service and healthcare administration. A REAL ID will be required beginning May 7, 2025, in accordance with 6 C.F.R. 37.5 (2021).

Major duties
Apply and interpret federal, state, Tribal, and private-sector regulations to determine patient eligibility and funding for healthcare programs. Analyze medical, financial, and eligibility documentation to resolve complex benefit, authorization, and coverage issues. Issue medical authorizations or denial determinations and coordinate with patients, providers, and agencies to support continuity of care. Maintain fund control records, monitor expenditures, apply accounting codes, and resolve program or funding discrepancies. Compile and analyze reports related to program operations, funding, and utilization.

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 GS-05 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: identifying and verifying patient eligibility for Medicare, Medicaid, SSA benefits, private insurance, Tribal programs, and other assistance resources; interviewing patients to obtain required documentation; assisting individuals and families with benefit applications; reviewing records to determine the status of claims and applications; responding to inquiries regarding patient eligibility requirements, benefits, and program guidelines; and maintaining accurate patient records through data entry, discrepancy resolution, and follow-up on pending claims and missing documentation. GS-07: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-06 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: determining patient eligibility and preparing or issuing medical authorizations and denial determinations in accordance with established regulations and program requirements; identifying and verifying alternate resource coverage, including Medicare, Medicaid, VA benefits, and private insurance; researching and resolving discrepancies related to eligibility, claims, medical authorizations, coverage, and supporting documentation; coordinating referrals and follow-up with healthcare facilities to support continuity of care; and responding to inquiries from patients, providers, and agencies regarding eligibility, claims, and program requirements. GS-08: 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: applying and interpreting complex federal, state, Tribal, and private-sector regulations to make eligibility and funding determinations for programs such as Purchased/Referred Care, Medicare, Medicaid, Veterans Affairs healthcare, and Affordable Care Act plans; independently analyzing medical, financial, and eligibility documentation to resolve complex or controversial benefit issues; coordinating with agencies, providers, and patients to ensure fiscal accountability and continuity of care; issuing medical authorizations or denial determinations based on regulatory, clinical, and fiscal requirements; maintaining fund control records, monitoring expenditures, and applying appropriate accounting codes; identifying and resolving program or funding discrepancies; and compiling and analyzing reports related to program operations, funding, and utilization. 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 cutoff day of rating to be eligible for referral.

How to apply
Please read the entire announcement and all the instructions before you begin an application. To apply and be considered for this position, you must complete all required questionnaires, assessments and submit all required documentation as specified in the How to Apply and Required Documents section. The complete application package must be submitted by 11:59 PM (ET) on the closing date of the announcement to receive consideration. The application process is as follows: Click the Apply Online button. Answer the questions presented in the application and attach all necessary supporting documentation. Click the Submit Application button prior to 11:59 PM (ET) on the announcement closing date. If you are required to complete any USA Hire Assessments, you will be notified after submitting your application. The notification will be provided in your application submission screen and via email. The notification will include your unique assessment access link to the USA Hire system and the completion deadline. Additionally, in USAJOBS you can click "Track this application" to return to your assessment completion notice. Access USA Hire using your unique assessment link. Access is granted through your USAJOBS login credentials. Review all instructions prior to beginning your assessments. You will have the opportunity to request a testing accommodation before beginning the assessments should you have a disability covered under the Rehabilitation Act of 1973 as amended. Set aside about two (2) hours to take the USA Hire Assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue later, you can re-use your unique assessment link. Your responses to the USA Hire Assessments will be reused for one year (in most cases) from the date you complete an assessment. If future applications you submit require completion of the same assessments, your responses will be automatically reused. Visit the USA Hire Applicant Resource Center for practice assessments and assessment preparation resources at https://support-usahire.opm.gov/hc/en-us. To update your application, including supporting documentation: During the announcement open period, return to your USAJOBS account, find your application record, and click Edit my application. This option will no longer be available once the announcement has closed. To view the announcement status or your application status: Visit https://www.usajobs.gov/Help/howto/application/status/. Your application status page is where you can view your application status, USA Hire assessment completion status, and review your notifications sent by the hiring agency regarding your application. You may update your application documents and some questions related to your personal information at any time during the announcement open period. Upon application, you may be provided a testing window to complete additional assessments. This testing window may stipulate a completion deadline before the announcement closes. It is your responsibility to complete the additional online assessments within the timeline provided to remain in consideration for this vacancy announcement. Failure to complete the online assessments within the testing window for this announcement will not preclude you from being considered for and completing the online assessments during a testing window on a future announcement. For additional questions please see our Frequently Asked Questions (FAQs) found here: https://www.ihs.gov/jobs/faq/.