Summary This position is located at the Phoenix Indian Medical Center (PIMC), Patient Business Services (PBS) Department, Third Party Billing, Accounts Receivable, and Claims Denial and Appeal Section in Phoenix, AZ. The incumbent is part of a team that is responsible for the examination, verification, and maintenance of data involved in processing, tracking, and generating alternate resources reimbursement and performing other related support duties. Responsibilities This position is being re-advertised to solicit additional applications. Applicants who applied previously need not reapply unless submitting updated and/or missing information. Posts and batches payments received on a daily basis. Also follows-up on non-payments, adjustments, and refunds. Reviews all incoming correspondence determining whether the claim is final; more medical information is needed; claim needs to be resubmitted; or claim needs to be forwarded for appeal. Actively performs audits and medical reviews to ensure documentation and accountability of all health insurance claims submitted for payment by conducting random sample reviews. Communicates directly with third party payers on the eligibility of patients to ensure the information in the RPMS are correct to ensure accurate billing. Requirements Conditions of Employment Must pass pre-employment examination. 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 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. 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/. A bank account at a financial institution is required for electronic direct deposit of salary payment. 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. MINIMUM QUALIFICATIONS: GS-5: Your resume must demonstrate at least one year of specialized experience at or equivalent to at least the GS-4 grade level in the Federal service obtained in either the private or public sector; Examples include: batching and posting payments received from third-party payers & following up on non-payments, adjustments, and refunds. OR Completed 4 years of education above high school. (Transcripts Required) OR Possess a combination of education and experience that when combined fully meet the minimum qualifications for this position. The total percentage equals at least 100 percent to qualify for this GS-05 grade level. Notes: Only education in excess of the first 60 semester hours (i.e., beyond the second year) is creditable toward meeting the specialized experience requirement. One full academic year of study (30 semester hours) beyond the second year is equivalent to 6 months of specialized experience. GS-6: Your resume must demonstrate at least one year of specialized experience at or equivalent to at least the GS-5 grade level in the Federal service obtained in either the private or public sector. Specialized experience qualifying for the GS-6 grade is defined as: examining, verifying, and maintaining data involved in processing, tracking, and generating alternate resources reimbursement; researching denied claims; & filing all pending and completed claims and correspondence relative to third-party programs. GS-7: Your resume must demonstrate at least one year of specialized experience at or equivalent to at least the GS-6 grade level in the Federal service obtained in either the private or public sector. Specialized experience qualifying for the GS-7 grade is defined as: preparing monthly, quarterly, and annual reconciliation of third-party billing to assure that collections, billed data, and computerized & manual reports are in balance; performing audits and medical reviews to ensure accountability of all health insurance claims submitted for payment; & establishing day-to-day billing procedures for all third-party programs. 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). 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/. 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. Recruitment and/or Relocation Incentives may be authorized and is subject to availability and service unit approval. If offered, you will be required to sign a one (1) year service agreement. Failure to fulfill the service agreement will result in repayment of the incentive. This position has promotion potential to the GS-07 grade level. Promotion to the next grade level is at management's discretion and is based on your demonstrated ability to perform the higher-level duties, the continuing need for the higher level duties, and "Regulatory/Administrative" approval. Promotion to the next higher grade level is not guaranteed and no promise of promotion is implied. This position is covered by a Bargaining Unit.