Public Health Eligibility & Authorization Specialist

The Indian Health Service; Warm Springs (OR); On-site; USD 48,000 - 64,000; Full time

Job summary

The Indian Health Service in Oregon is seeking a Contact Representative to assist American Indian communities with eligibility, authorizations, referrals, and benefits, supporting access to essential healthcare services.

You will review medical and financial documents, determine funding eligibility, issue authorizations or denials, and coordinate with patients and providers to ensure continuity of care while complying with federal regulations.

Qualifications

• GS-06: 1 year of specialized experience in eligibility for Medicare/Medicaid, SSA benefits, Tribal programs, and other assistance resources.
• GS-07: 1 year of specialized experience at GS-06 level in eligibility, medical authorizations, and coordination of referrals.
• GS-08: 1 year of specialized experience at GS-07 level applying complex regulations to determinations and funding.

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.

Skills

Eligibility determination

Documentation review

Communication with patients

Job description

The Indian Health Service in Oregon is seeking a Contact Representative to assist American Indian communities with eligibility, authorizations, referrals, and benefits, supporting access to essential healthcare services.

You will review medical and financial documents, determine funding eligibility, issue authorizations or denials, and coordinate with patients and providers to ensure continuity of care while complying with federal regulations.