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USAJOBS · 2 months ago

Claims Management Program Analyst (O-4 Billet) Non-Supervisory

Washington, District of Columbia, USA

Full-time

Onsite

Mid Level

3+ years exp

USAJOBS is part of the Department of Homeland Security, specifically the Immigration and Customs Enforcement agency. The Claims Management Program Analyst supports the Health Plan Management Unit by managing claims, provider recruitment, and ensuring compliance with healthcare standards.

ConsultingGovernmentHuman ResourcesInformation TechnologyInternetStaffing Agency

No H1B

U.S. Citizen Only

Responsibilities

Serves in the capacity as a Claims Management Program Analyst; handles and assists program activities and policies related to claims management, and provider recruitment

Assumes leadership role as acting claims management program analyst lead when necessary

Serves as CMP representative between IHSC, third-party administrator, CBP components, and ICE ERO components in coordinating care and recruitment of off-site community provider for illegal aliens

Assist in developing, evaluating, and coordinating CMP related functions to ensure adherence to industry practices in eligibility verification, authorization of care, claims management denials and appeals to minimize adverse outcomes related to timely filing and maintaining a Provider Network to provide quality specialty care to illegal aliens

Duties include assisting in day-to-day managing, assessing, planning, developing, implementing, and evaluating assigned programs. Incumbent assists with reviews of policies. Incumbent ensures compliance with program regulations (e.g., appropriateness of health care and services based on regulatory, reimbursement requirements, evidence-based national care guidelines and evidence-based practices), maintains records per program policy, coordinates and, or manages programs within immediate organizational component. Communicates and collaborates with individuals or groups from outside the agency, including consultants and contractors. Work purpose is primarily to collaborate; supply advice; explain, interpret, and seek support for methods, policies and programs; or render a service of a moderately complex nature requiring a moderate amount of explanation and tact (e.g., support for budget)

Liaise regionally and, or, nationally with applicable stakeholders internal and external stakeholders (e.g., U.S. Customs and Border Patrol, third party administrator and off-site community providers) regarding medical claims processes, trainings, and principles

Provides guidance to the respective ICE custody, and medical staff members of facilities in which and ICE illegal aliens are held regarding ICE policies, reporting requirements, and applicable ICE detention standards

Judgmental failure can result in ineffective or inappropriate use of resources and delays in meeting public health objectives of the office or agency. This may also impair the development of systems, affect the work of subordinate employees, and compromise the delivery of other administrative and personnel services

Travel may be required - estimated 15%

Travels TDY as needed to provide clinical care support at IHSC-staffed detention facilities with critical staffing needs

Performs other duties and responsibilities as assigned

Qualification

Claims managementHealthcare managementProgram managementHIPAA complianceMedical codingElectronic health recordsMicrosoft OfficeAnalytical skillsCommunication skills

Required

Incumbent must possess a minimum of three years of professional experience relevant to the officer's category. Of the total professional experience, officer must possess at least two years of experience related to program management, administration, Healthcare management, finance or medical claims is preferred

Qualifying degree for the officer's category from an accredited institution

If the incumbent holds a clinical license, it is the responsibility of the incumbent to fulfill the obligation(s) of their licensing or certifying body to maintain status. The agency may require the incumbent performs clinical activities with the scope of clinical license in times of critical needs within the agency. If in a clinical discipline and as directed and approved by his/her supervisors, the incumbent may perform clinical duties of their profession in Federal health care facilities. Such direction is documented via a memorandum of assignment and is filed in the eOPF

Well-developed knowledge and skills in the areas of claims management and medical necessity

Knowledge of medical, administrative, ethical, and legal requirements and standards related to healthcare delivery

Should possess some knowledge of International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), current procedural terminology (CPT), diagnosis-related group (DRG), and other Centers for Medicare and Medicaid Services (CMS) coding/billing requirements

Experience utilizing and navigating electronic health records and other web-based application programs

Ability to critically analyze situations, data, and information, and be able to develop and pose probing questions, identify problems, and make recommendations towards their resolution

Maintains clinical professional skills via continuing education opportunities

Computer literate on MicroSoft Office applications, and Sharepoint applications

Benefits

Relocation expenses reimbursed: Yes—You may qualify for reimbursement of relocation expenses in accordance with agency policy.

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.