Healthcare Eligibility & Authorization Specialist

The Indian Health Service; Madison Heights (VA); On-site; USD 52,000 - 70,000; Full time

Job summary

The Indian Health Service is seeking a Contact Representative to support access to healthcare services for American Indian communities. You will help patients with eligibility, medical authorizations, referrals, and healthcare benefits while contributing to public service and healthcare administration.

In this role you will review documentation, apply federal and tribal guidelines, issue authorizations or denials, and collaborate with patients, providers, and agencies to ensure continuity of

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.

Responsibilities

• Apply and interpret federal, state, Tribal, and private‑sector regulations to determine patient eligibility and funding for healthcare programs.
• Analyze medical, financial, and eligibility documentation to resolve complex benefit, authorization, and coverage issues.
• Issue medical authorizations or denial determinations and coordinate with patients, providers, and agencies to support continuity of care.
• Maintain fund control records, monitor expenditures, apply accounting codes, and resolve program or funding discrepancies.
• Compile and analyze reports related to program operations, funding, and utilization.

Job description

The Indian Health Service is seeking a Contact Representative to support access to healthcare services for American Indian communities. You will help patients with eligibility, medical authorizations, referrals, and healthcare benefits while contributing to public service and healthcare administration.

In this role you will review documentation, apply federal and tribal guidelines, issue authorizations or denials, and collaborate with patients, providers, and agencies to ensure continuity of