Supervisory Health System Specialist (Third Party Billing)

Summary

This position is located in the Division of Financial Services at the Phoenix Indian Medical Center. The incumbent serves as a Supervisor for Third Party Billing (TPB) Section, functions include assuring a timely efficient system of reviewing billing claims with TPB package and issuing payments from third party resources; perform a variety of management analysis assignments to determine their efficiency. A REAL ID will be required beginning May 7, 2025, in accordance with 6 C.F.R. 37.5 (2021).

Duties

• Total Compensation Package - Check out IHS's outstanding total compensation package for this job: Health System Specialist Total Compensation | Pay (ihs.gov) Performs long and short-term analysis to determine efficiency of Third Party Billing systems. Prepares workload and production reports to measure their impact on Third Party Billing programs. Supervises and trains employees of Third Party Billing operations. Analyzes and evaluates management practices to identify deficiencies in the billing of services transactions. Compiles data on billing of services transactions for review to management. Processes payments and/or non-payments of patients through alternate resources (i.e. Medicare, Medicaid, Private Insurance, Commission Officers Tricare, and third party liability claims). Investigates and solves complaints between beneficiaries, healthcare providers, and Private insurance companies regarding debt collection, eligibility, and nonpayment or incorrect payment claim.

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 REQUIREMENTS Individual Occupational Requirements General Schedule Qualification Standards - Health System Administration Series 0671 Education: 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; OR 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. Special Provision for In-Service Placement: Successful complete of an agency-sponsored on-the-job training program may be substituted for qualifying experience, provided it included a formal individualized training plan. Such a training program must have been conducted in an operating health care system and included: Assignments providing a knowledge of basic health system administration philosophies, practices, and procedures, and basic government administrative policies and requirements; Practical assignments providing an opportunity to apply health system administration skills and principles (as the individual progresses, work assignments must be characteristic of the grade level to which he or she is assigned); and Oversight by an experienced health system administrator with periodic evaluation of the individual's progress and appropriate adjustment of the training program. In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. MINIMUM QUALIFICATIONS: GS-0671-11:Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-09 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Examples include: Review billing claims in a timely efficient matter using Third Party Billing systems and apply Third Party Billing functions, such as examining, verifying, and maintaining data of transactions in a health care delivery system and other regulatory systems; Perform long and short-term analysis to determine efficiency of Third Party Billing, analyze and evaluate management practices, develop or update position descriptions, performance standards and evaluates subordinates performance; trains develops and orientates subordinates. -OR- Completed a Ph.D. or equivalent doctoral degree or 3 full years (54 semester hours) of progressively higher level graduate education leading to such a degree, such education must demonstrate the knowledge, skills, and abilities necessary to do the work or LL.M., if related. (Must provide transcripts) -OR- Combination of the specialized experience and education described above. To determine if you qualify under this combination first divide your total months of qualifying experience by 12. Then divide your semester hours of graduate education beyond 2 years by 18. (Note: Only education in excess of the second year is creditable toward meeting the experience requirement when combining experience and education.) Finally, add the two percentages. The total percentage must equal at least 100 percent to qualify. (Must provide transcripts) 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.

Requirements

Selectee may be subject to a probationary 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. A one-year supervisory/managerial probationary period may be required upon selection/placement. Confidential Financial Disclosure Form required. 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 Requirement: This position requires the successful completion of a federal background investigation as a condition of employment. A background investigation is a standard process used by the Federal Government to verify an individual's identity, employment history, education, and other relevant information to determine suitability for Federal service. Upon receipt of instructions, applicants must complete all required background investigation forms within five (5) calendar days of issuance. Timely completion is critical to avoid delays in processing or a determination of unsuitability. Applicants are strongly encouraged to prioritize this requirement and to maintain regular communication with their assigned Personnel Security Specialist throughout the process. Financial Suitability Requirement: This position requires a review of the applicant's financial history as part of the personnel security and suitability determination. Applicants must demonstrate financial responsibility, maintain good standing with creditors, and satisfy all legal financial obligations prior to applying. Individuals with substantial delinquent or unresolved financial obligations-including, but not limited to, delinquent federal or state tax liabilities, defaulted federal student loans, court-ordered fines or fees, or child support arrears-may be deemed unsuitable for employment with the Indian Health Service (IHS). Prior to the appointment, candidates must present two valid forms of identification. If one of the documents is a state-issued ID or driver's license, it must be REAL ID-compliant.

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. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

How to apply

To apply for this position, you must provide a complete Application Package. See required documents below. To begin, click the Apply Online button on the vacancy announcement. You will be directed to the Login.Gov screen, here will you sign in if you have an existing USAJOBS account or Create a Login.Gov account. If you have an account you will be directed to select a resume or create a resume. If you create an account you can create an resume. Click save and continue. Follow the prompts to upload your resume and/or supporting documents. Click the Apply To This Vacancy and complete all steps in the application process until the Confirmation indicates your application is complete. If you click Return to USAJOBS or get timed out prior to receiving confirmation, your application will not be submitted and cannot be considered for this job. Read and complete all Eligibility questions. Review the REQUIRED DOCUMENTS section of this announcement to determine which apply to you and must be submitted online. You may choose one or more of the following options to submit your document(s): Upload (from your computer) or USAJOBS (click the "USAJOBS" link to complete the transfer process). For additional questions please see our Frequently Asked Questions (FAQs) found here: https://www.ihs.gov/jobs/faq/. The IHS provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application and hiring process, please notify the Human Resources Office (Tonia Becenti, [email protected], and/or 928-871-1311.) The decision on granting reasonable accommodation will be on a case-by-case basis.