Health System Specialist (Business Office)

Summary
This position is located in the Business Office of the Rosebud IHS Service Unit. The functions of this position will include; 1) Prior Authorizations/Pre-Certifications; 2) Provider Enrollment; 3) Appeals; and 4) Accounts Receivable.
This job is open to

• Career transition (CTAP, ICTAP, RPL)
  Federal employees who meet the definition of a "surplus" or "displaced" employee.
• Federal employees - Competitive service
  Current or former competitive service federal employees.
• Federal employees - Excepted service
  Current excepted service federal employees.
• Individuals with disabilities
• Land & base management
  Certain current or former term or temporary federal employees of a land or base management agency.
• Native Americans
  Native Americans or Alaskan Natives with a tribal affiliation.
• Peace Corps & AmeriCorps Vista
• Veterans

Clarification from the agency
The IHS is required by law to give absolute preference to qualified applicants who meet the Secretary of the Interior's definition of Indian for appointment to vacancies within the IHS in accordance with established IHS policy as outlined in the Indian Health Manual Part 7, Chapter 3. The IHS is an Equal Opportunity Employer.
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Duties

• 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.
Confidential Financial Disclosure Form may be required.
Measles and Rubella immunization required for selectees born after 1957 and seasonal influenza immunization is required for all staff working in Indian Health Service health care facilities.
COVID-19 vaccination is required for all selectees prior to entrance on duty.
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):
OPM Link: Health System Administration Series 0671 (opm.gov)
Specialized Experience (for positions above GS-5): 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-9: One (1) years of specialized experience equivalent to at least the GS-7 grade level and/or master's or equivalent graduate degree OR 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:
Specialized Experience
GS-9: 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.
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
Per IHS policy (SGM 21-04) IHS selectees to positions located in Federally operated hospitals, health centers, and clinics must be fully vaccinated for COVID-19 before entry on duty or have IHS approve a medical or religious exemption. If an exemption is approved then wearing a face mask and regular testing for COVID-19 will be required. Your Human Resources Specialist will provide a list of documents acceptable as vaccination proof and instructions on how to submit your vaccination documentation or how to request a medical or religious exemption, if needed.
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.
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/.

• Benefits
  A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
  Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

How You Will Be Evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.
To determine if you are qualified for this position, a review of your resume and supporting documentation will be made and compared against the qualifications as defined in the qualifications section of this vacancy announcement and your responses to the assessment questions.
You will be further evaluated/rated based on the information provided in your resume (your resume must state specific duties that relate to this position) and your responses to the assessment questions to determine your competency in the following.

• Oral Communication
• Planning and Evaluating
• Technical Competence
• Technology Application

You will receive a numeric rating based on your responses to the assessment questionnaires. If after reviewing your resume and responses to the assessment questions, a determination is made that you have overstated your qualifications and or experience, you may lose consideration.
The following links below provide information on how you may be eligible for various hiring authorities. If you are a Veteran, qualified CTAP and ICTAP eligible, or an individual with a disability, please refer to the following links below for additional guidance. CTAP and ICTAP candidates will be eligible for selection priority if it is determined that they have exceeded the minimum qualifications for the position by attaining at least a "well qualified" rating of 85 out of 100. Information about CTAP and ICTAP eligibility is on the Office of Personnel Management's Workforce Restructuring Career Transition website at: https://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/. CTAP/ICTAP documentation requirements are listed in the "Required Documents" section of this announcement.

• Veterans, i.e. (VEOA, VRA, and 30% or more disabled) - https://www.opm.gov/policy-data-oversight/veterans-services/vet-guide-for-hr-professionals/
• Career Transition Assistance Program (CTAP) - https://www.ihs.gov/jobs/support-documents/
• Interagency Transition Assistance Program (ICTAP) - https://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/
• Schedule A Appointments for the Disabled - https://www.opm.gov/policy-data-oversight/disability-employment/hiring/

Click here to view vacancy questions: https://apply.usastaffing.gov/ViewQuestionnaire/12217200. All documents above MUST be received by 11:59 pm (Eastern Standard Time) of the closing date of, 12/08/2023, to be considered.

• Benefits
  A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
  Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.
• Required Documents
  As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have - whether you're a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you're eligible under their policies.
  Resume: You are highly encouraged to use USAJOBS Resume Builder to ensure all required information is included in your Resume. If you use your own resume, curriculum vitae, or any other written form you choose then you must describe your job-related qualifications that includes beginning and ending dates for paid and non-paid work experience, hours worked per week, month and year of employment for each job title listed, annual salary, and description of job duties. Include name and address of employer; supervisor name and telephone number.
  Required as applicable for the purposes of specific eligibility and appointment claim(s), and position requirements:
  Indian Pr...