Billing Technician

Summary This position is located in the Pharmacy Branch of the Gallup Indian Medical Center in Gallup, New Mexico. The main purpose of this position is to review information from records and use it to prepare and submit accurate point-of-sale billing claims. The job requires good analytical skills, sound judgment, discretion, and knowledge of administrative and program policies, procedures, and goals. A REAL ID will be required beginning May 7, 2025, in accordance with 6 C.F.R. 37.5 (2021). Responsibilities Receives and examines alternate resource claims to assure claims are complete with appropriate supporting documents which typically include utilization review certifications. Verifies accuracy of health claims number that claimed amounts are authorized and items of services billed are allowed by appropriate regulations, decisions, directives and other controlling guides. Provides technical assistance with processing and maintaining coding, abstraction of the complete chart (outpatient) and compliance enforcement of all regulatory requirements. Review, analyze Current Procedural Terminology (CPT) coding, abstract and compile date, maintain and identify potential risk areas in outpatient medical record. Conducts a thorough review of all abstraction and search of records, guidelines in order to select the most accurate and descriptive codes in accordance with coding systems. Code selection involves discriminating between several different codes, which can overlap in scope, encompass multiple diagnosis, treatments or operations; and include special codes to denote causes of accident/injury or adverse effects required for billing. Consults with the attending physician, laboratory and all other necessary departments for compliance with all the regulations and guidelines pertinent to False Claims Act and facilities Compliance Program in preparation for itemize billing. Requirements Conditions of Employment Selectee may be subject to a probationary period ESEP appointees typically serve a two year trial period U.S. Citizenship is required Selective Service Registration is required for males born after 12/31/1959 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. Financial Suitability Requirement: This position requires a review of the applicant's financial history as part of the personnel security and suitability determination. Applicants must demonstrate financial responsibility, maintain good standing with creditors, and satisfy all legal financial obligations prior to applying. Individuals with substantial delinquent or unresolved financial obligations-including, but not limited to, delinquent federal or state tax liabilities, defaulted federal student loans, court-ordered fines or fees, or child support arrears-may be deemed unsuitable for employment with the Indian Health Service (IHS). Prior to the appointment, candidates must present two valid forms of identification. If one of the documents is a state-issued ID or driver's license, it must be REAL ID-compliant. 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 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. Examples include: completing insurance audits, prior authorizations, work in a medical business office setting with responsibility for performing submission to third party payers, intermediaries, and patients, documenting all activity performed, submission of daily productivity reports to the supervisor. 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. Examples include: completing insurance audits, prior authorizations, submitting claims to third party payers and responsible parties, rebilling or correcting billing of accounts previously submitted. This experience also includes such things as verifying information, reviewing reports to identify claims and using the various types of computer systems. 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. 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. This position has promotion potential to the GS-GS-7 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? How would you help advance the President's Executive Orders and policy priorities in this role? 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).