Health System Specialist (Provider Enrollment)

Indian Health Service; Phoenix (AZ); On-site; USD 54,000 - 66,000; Full time

Job summary

Indian Health Service is seeking a Provider Enrollment Specialist at the Phoenix area to initiate enrollment applications for CMS and multiple state Medicaid programs, ensuring compliance and timely processing.

The role requires specialized health care administration experience, with demonstrated ability to liaise with providers and regulatory agencies. A graduate degree in health care management is preferred.

Qualifications

• One year of specialized experience at GS-07 level in federal service related to enrollment and liaison with providers and agencies.
• Experience reviewing and completing CMS, state Medicaid, and managed care applications.
• Experience assisting medical staff with Medicaid attestations and enrollment processes.
• Analytical experience evaluating program operations and outcomes.
• Possess a combination of education and experience that meets the minimum qualifications.

Responsibilities

• Initiate provider and facility enrollment applications for CMS, AHCCCS, and other Medicaid programs.
• Serve as liaison with providers, state agencies, and business office personnel.
• Assist medical staff with Medicaid attestation and enrollment processes.
• Analyze program operations to evaluate effectiveness and compliance.

Skills

Specialized health care administration

CMS and Medicaid enrollment liaison

Provider enrollment coordination

Analytical / data evaluation

Interagency coordination

Education

Master's degree in hospital/public health administration or related field

Graduate coursework in health care administration

Job description

Located at the Phoenix Indian Medical Center (PIMC), in Phoenix, Arizona. Incumbent serves as the Provider Enrollment Specialist, responsible for initiating provider and facility enrollment applications for Centers for Medicare and Medicaid Services (CMS), Arizona Medicaid (AHCCCS), California Medicaid (Medi-Cal), Nevada Medicaid, New Mexico Medicaid, and various private insurance or managed care plans. 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.

BASIC REQUIREMENT(S):

Individual Occupational Requirements 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 (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/ou 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
• Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement

Special Provision for Inservice 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)
• 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 Individual Occupation Requirements, you must also meet the Minimum Qualifications stated below.

MINIMUM QUALIFICATIONS - GS-9:

• 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: responsible for the evaluation and reporting and performs liaison functions with providers, state and local agencies, and business office personnel
• Served as a facility or provider authorized organizational official to review and complete CMS, state Medicaid, private insurance, and managed care applications
• Assists and supports medical staff to complete state Medicaid attestation and enrollment process
• Analyzes and evaluates (on a quantitative or qualitative basis) the effectiveness of program operations
• Master's degree or equivalent degree that included the major study in hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration
• Completion of two full years of progressively higher-level graduate education leading to such a degree that included major study - hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration
• LL.B. or J.D., if related, that included major study -- hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration
• Possess a combination of education and experience that when combined fully meet the minimum qualifications for this position

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