Contact Representative (PRC)

Summary 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). Duties 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. Requirements Conditions of employment Selectee may be subject to a probationary period U.S. Citizenship is required Selective Service Registration is required for males born after 12/31/1959 This is a competitive vacancy announcement advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served, and all other Federal entitlements would remain the same. IHS Selectees whose duties and responsibilities require them to work permanently, temporarily, or occasionally in an IHS healthcare facility must comply with the IHS Employee Immunization Policy related to vaccine‑preventable diseases, consistent with recommendations for healthcare workers. Vaccine exemption requests may be available, as outlined in the IHS Employee Immunization Policy and facility guidance. This is a designated position covered by Public Law 101‑630, requiring contact or control over Indian children. Due to this requirement, the agency must ensure that persons hired for these positions have not been found guilty of or pleaded nolo contendere or guilty to certain crimes. Successfully pass the E‑Verify employment verification check. To learn more about E‑Verify, including your rights and responsibilities, visit You will need to set up direct deposit so we can pay you. Background Investigation Requirement This position requires the successful completion of a federal background investigation as a condition of employment. A background investigation is a standard process used by the Federal Government to verify an individual's identity, employment history, education, and other relevant information to determine suitability for Federal service. Upon receipt of instructions, applicants must complete all required background investigation forms within five (5) calendar days of issuance. Timely completion is critical to avoid delays in processing or a determination of unsuitability. Applicants are strongly encouraged to prioritize this requirement and to maintain regular communication with their assigned Personnel Security Specialist throughout the process. This position is also being advertised under ESEP/MP announcement number IHS‑27‑HQ‑13068258‑ESEP/MP. Qualifications 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. 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: 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. GS‑07: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS‑06 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 and preparing or issuing medical authorizations and denial determinations in accordance with established regulations and program requirements; identifying and verifying alternate resource coverage, including Medicare, Medicaid, VA benefits, and private insurance; researching and resolving discrepancies related to eligibility, claims, medical authorizations, coverage, and supporting documentation; coordinating referrals and follow‑up with healthcare facilities to support continuity of care; and responding to inquiries from patients, providers, and agencies regarding eligibility, claims, and program requirements. GS‑08: 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: applying and interpreting complex federal, state, Tribal, and private‑sector regulations to make eligibility and funding determinations for programs such as Purchased/Referred Care, Medicare, Medicaid, Veterans Affairs healthcare, and Affordable Care Act plans; independently analyzing medical, financial, and eligibility documentation to resolve complex or controversial benefit issues; coordinating with agencies, providers, and patients to ensure fiscal accountability and continuity of care; issuing medical authorizations or denial determinations based on regulatory, clinical, and fiscal requirements; maintaining fund control records, monitoring expenditures, and applying appropriate accounting codes; identifying and resolving program or funding discrepancies; and compiling and analyzing reports related to program operations, funding, and utilization. You must meet all qualification requirements within 30 days of the closing date of the announcement. Education There are no education requirements. Additional information Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case‑by‑case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments. ( Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. IHS may offer newly‑appointed Federal employees credit for their directly related previous non‑federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which they earn annual leave. This position is covered by a Bargaining Unit. Recruitment or relocation incentives may be authorized. At least a 6 month service agreement will be required. This position has promotion potential to the GS‑GS‑8 grade level. Promotion to the next grade level is at management's discretion and is based on your demonstrated ability to perform the higher level duties, the continuing need for the higher level duties, and "Regulatory/Administrative" approval. Promotion to the next higher grade level is not guaranteed and no promise of promotion is implied. You will be evaluated for this position in accordance with the OPM Merit Hiring Plan. As part of the application process, you will be asked to provide short essay responses (200 words or less each) to the following four questions. How has your commitment to the Constitution and the founding principles of the United States inspired you to pursue this role within the Federal government? In this role, how would you use your skills and experience to improve government efficiency and effectiveness? In this role, you will be expected to professionally and efficiently implement executive direction. Provide an example where you implemented leadership direction on a strategy or policy decision that differed from your own recommendation. How has a strong work ethic contributed to your professional, academic or personal achievements? Your responses are optional and will not be scored. However, they may be reviewed by hiring managers and agency leadership (or designees) during the evaluation process. You will be asked to certify that your responses are written in your own words and that you did not use a consultant or artificial intelligence (AI) tool (such as ChatGPT or Copilot). Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution. Benefits A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits. Review our benefits Eligibility for benefits depends on the type of position you hold and whether your position is full‑time, part‑time or intermittent. Contact the hiring agency for more information on the specific benefits offered. #J-18808-Ljbffr The Indian Health Service