Contact Representative (PRC)

Indian Health Service; United States; On-site; USD 55,000 - 75,000; Full time

Job summary

The Indian Health Service seeks a Contact Representative to help American Indian communities access healthcare. You will assist with eligibility, medical authorizations, referrals, and benefits while ensuring accurate records and compliant processes.

This role emphasizes customer service, data entry, and coordination with clinics; you'll work in a federal environment, adhere to regulations, and contribute to public service.

Qualifications

• Experience or education in eligibility and benefits tasks.
• Ability to interview patients and collect required documentation.
• Ability to maintain accurate patient records and data entry.

Responsibilities

• Identify and verify patient eligibility for Medicare, Medicaid, SSA benefits, private insurance, Tribal programs, and other resources.
• Interview patients to obtain required documentation.
• Assist individuals and families with benefit applications.
• Review records to determine the status of claims and applications.
• Respond to inquiries regarding eligibility requirements, benefits, and program guidelines.
• Maintain accurate patient records through data entry, discrepancy resolution, and follow-up on pending claims.
• Determine eligibility and issue medical authorizations and denial determinations.
• Coordinate referrals and follow-up with healthcare facilities to support continuity of care.

Skills

Customer service

Data entry

Communication

Job description

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).

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.

You must meet all qualification requirements within 30 days of the closing date of the announcement.