Healthcare Eligibility & Authorization Specialist

The Indian Health Service; Salem (OR); On-site; USD 52,000 - 78,000; Full time

Job summary

The Indian Health Service in Salem, Oregon seeks a Contact Representative to support eligibility, medical authorizations, referrals, and healthcare benefits for American Indian communities.

Responsibilities include analyzing documentation, determining funding, issuing authorizations, maintaining records, and generating program reports to ensure continuity of care in a federal healthcare system.

Qualifications

• GS-06: at least 1 year of specialized experience identifying and verifying patient eligibility for Medicare/Medicaid/SSA or Tribal programs.
• GS-07: at least 1 year of specialized experience determining eligibility and issuing medical authorizations.
• GS-08: at least 1 year at GS-07 level handling complex eligibility, funding, and coordination tasks.

Responsibilities

• Apply and interpret regulations to determine patient eligibility and funding for healthcare programs.
• Analyze medical, financial, and eligibility docs to resolve benefit, authorization, and coverage issues.
• Issue medical authorizations or denial determinations and coordinate with patients, providers, and agencies.
• Maintain fund control records, monitor expenditures, apply accounting codes, and resolve discrepancies.
• Compile and analyze reports related to program operations, funding, and utilization.

Skills

Patient eligibility

Documentation review

Interviews with patients

Job description

The Indian Health Service in Salem, Oregon seeks a Contact Representative to support eligibility, medical authorizations, referrals, and healthcare benefits for American Indian communities.

Responsibilities include analyzing documentation, determining funding, issuing authorizations, maintaining records, and generating program reports to ensure continuity of care in a federal healthcare system.