What are the responsibilities and job description for the Contact Representative (Benefits Coordinator) position at Department Of Health And Human Services?
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). EDUCATION: There are no education requirements.
RESPONSIBILITIES:
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: determining patient eligibility for alternate resources programs; interpreting and applying Medicare, Medicaid, VA, and other third-party payer policies and procedures; conducting patient interviews to identify available healthcare coverage and funding sources; assisting patients with enrollment and claims processes; researching and resolving eligibility, denial, and reimbursement issues; maintaining effective working relationships with patients and resource agencies; and safeguarding confidential patient information in accordance with Privacy Act and HIPAA requirements.
GS-07: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: assisting patients with alternate resources and eligibility processes; conducting patient interviews to obtain information for program eligibility and enrollment; providing information on Medicare, Medicaid, Tribal, and other healthcare programs; reviewing applications and supporting documentation for completeness; coordinating with patients and outside agencies to obtain required information; maintaining confidential patient records; and applying established policies, procedures, and guidelines in a healthcare setting.
GS-08: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: interpreting and applying federal, state, Tribal, and third-party program regulations to determine eligibility and ensure compliance for programs such as Purchase Referred Care, Medicare, Medicaid, Affordable Care Act, Veterans Affairs Healthcare, and other alternate resources; conducting in-depth patient interviews to assess eligibility, verify coverage, and complete applications; registering eligible patients in various assistance programs; resolving claim denials and eligibility issues through coordination with patients, healthcare providers, and outside agencies; reviewing Medicaid eligibility information and supporting billing requirements; and utilizing effective oral and written communication to explain program requirements, provide referrals, and resolve complex patient service issues.
Time In Grade
Federal employees in the competitive service are also subject to the Time-In-Grade Requirements: Merit Promotion (status) candidates must have completed one year of service at the next lower grade level. Time-In-Grade provisions do not apply under the Excepted Service Examining Plan (ESEP).
You must meet all qualification requirements within 30 days of the closing date of the announcement. SALARY: 45409 EMPLOYMENT TYPE: Other
A REAL ID will be required beginning May 7, 2025, in accordance with 6 C.F.R. 37.5 (2021). EDUCATION: There are no education requirements.
RESPONSIBILITIES:
- Assists patients in identifying and obtaining alternate health care resources, including Medicare, Medicaid, VA, Tribal, and other third-party programs.
- Conducts patient interviews to gather information for eligibility determinations and enrollment.
- Assists with completing applications, verifying eligibility, and maintaining enrollment records.
- Provides information regarding benefits, coverage, program requirements, and available resources.
- Coordinates with patients, families, healthcare staff, and external agencies to obtain required information and facilitate referrals.
- Follows up on pending applications, enrollments, and claims to support timely processing.
- Assists in resolving eligibility, coverage, and reimbursement issues in accordance with established policies and procedures.
- Maintains confidential patient information and records in compliance with Privacy Act and HIPAA requirements.
- Utilizes automated systems to document, track, and report eligibility and enrollment activities.
- Supports patient access to healthcare services through effective customer service and application of alternate resource program requirements.
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: determining patient eligibility for alternate resources programs; interpreting and applying Medicare, Medicaid, VA, and other third-party payer policies and procedures; conducting patient interviews to identify available healthcare coverage and funding sources; assisting patients with enrollment and claims processes; researching and resolving eligibility, denial, and reimbursement issues; maintaining effective working relationships with patients and resource agencies; and safeguarding confidential patient information in accordance with Privacy Act and HIPAA requirements.
GS-07: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: assisting patients with alternate resources and eligibility processes; conducting patient interviews to obtain information for program eligibility and enrollment; providing information on Medicare, Medicaid, Tribal, and other healthcare programs; reviewing applications and supporting documentation for completeness; coordinating with patients and outside agencies to obtain required information; maintaining confidential patient records; and applying established policies, procedures, and guidelines in a healthcare setting.
GS-08: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: interpreting and applying federal, state, Tribal, and third-party program regulations to determine eligibility and ensure compliance for programs such as Purchase Referred Care, Medicare, Medicaid, Affordable Care Act, Veterans Affairs Healthcare, and other alternate resources; conducting in-depth patient interviews to assess eligibility, verify coverage, and complete applications; registering eligible patients in various assistance programs; resolving claim denials and eligibility issues through coordination with patients, healthcare providers, and outside agencies; reviewing Medicaid eligibility information and supporting billing requirements; and utilizing effective oral and written communication to explain program requirements, provide referrals, and resolve complex patient service issues.
Time In Grade
Federal employees in the competitive service are also subject to the Time-In-Grade Requirements: Merit Promotion (status) candidates must have completed one year of service at the next lower grade level. Time-In-Grade provisions do not apply under the Excepted Service Examining Plan (ESEP).
You must meet all qualification requirements within 30 days of the closing date of the announcement. SALARY: 45409 EMPLOYMENT TYPE: Other