This position is located in the Billings Area Office, Office of Administrative Support, Purchased/Referred Care department (PRC) in Billings, MT. The purpose of this position is to manage the Area PRC department, directly supervise the PRC staff and serve as the Area technical consultant for the Area Service Units and tribes that cover two (2) states. This position reports to the Director of Revenue.
Learn more about this agency
Work with Headquarter's, Area Office and Service Unit professional staff on comprehensive program planning to insure that the PRC program is effectively integrated into a comprehensive health care delivery system.
Independently define and develop contract requirements and serve as lead negotiator in negotiation of contracts with private vendors.
Implement and administer comprehensive PRC denial and appeal procedures; respond to all PRC inquiries and requests for health care assistance.
Conduct and participate in reviews and evaluations of Area CHS operations of Service Units and tribes to determine progress, conformity to program requirements and identify deficiencies and problems affecting costs and delivery of service.
Assure equitable distribution and management of PRC funds allocated to the Area or collected through third party alternate resources.
25% or less - You may be expected to travel for this position.
Job family (Series)
0671 Health System Specialist
HelpRequirements Conditions of Employment
Selectee will be subject to a pre-employment fingerprint check.
Selectee will be subject to a pre-employment background investigation.
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
Selectee may be subject to a probationary/trial period.
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.
For positions requiring positive education requirements, or if you are using education to meet all or part of the qualification requirements, you MUST submit a copy of your transcripts or an itemized list of college courses which includes equivalent information from the transcript (course title, semester/quarter hours, and grade/degree earned) in your resume.
INDIVIDUAL OCCUPATIONAL REQUIREMENTS
Undergraduate and Graduate Education
Major Study: Hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration.
Progressively responsible analytical or administrative, or clinical management or supervisory experience in the health care field. This work may have been performed in an operating health care facility or a higher organizational echelon with advisory or directional authority over such facilities. Work must have involved a close working relationship with facility managers and analysis and/or coordination of administrative, clinical, or other service activities, and provided knowledge of the following:
Missions, organizations, programs, and requirements of health care delivery systems;
Regulations and standards of various regulatory and credentialing groups; and
Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement.
Applicants must also possess: Management ability to delegate authority, evaluate and oversee people and programs, recognize and adapt to changing priorities; and Knowledge of the interrelationships and interdependencies among various medical and administrative services and programs.
GS-11: One (1) year of specialized experience equivalent to at least the GS-9 grade level OR a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher education leading to such a degree or LL.M., if related.
GS-12: One (1) year of specialized experience equivalent to at least the GS-11 grade level.
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:
GS-11: Apply contract care, alternate resources and reimbursement aspects in health care delivery process. Develop contract requirements for vendor negotiations. Comply with patient referral system policies, procedures and guidelines.
GS- 12: Develop contract requirements for vendor negotiations. Apply laws and regulations pertaining to health care delivery and contracts. Comply with patient referral system policies, procedures and guidelines. Perform data analysis to identify problems and recommend solutions. Apply contract care, alternate resources and reimbursement aspects in health care delivery process.
NOTE: Equivalent combinations of education and experience are qualifying for all grade levels for which both education and experience are acceptable.
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).
Department Of Health And Human Services