Health System Specialist (Provider Enrollment)

This Health System Specialist (Provider Enrollment) position is with Indian Health Service (Department of Health and Human Services) in Phoenix, AZ. Located at the Phoenix Indian Medical Center (PIMC), in Phoenix, Arizona. Incumbent serves as the Provider Enrollment Specialist, responsible for initiating provider and facility enrollment applications for Centers for Medicare and Medicaid Services (CMS), Arizona Medicaid (AHCCCS), California Medicaid (Medi-Cal), Nevada Medicaid, New Mexico Medicaid, and various private insurance or managed care plans. A REAL ID will be required beginning May 7, 2025, in accordance with 6 C.F.R. 37.5 (2021). Key duties: • Total Compensation Package - Check out IHS's outstanding total compensation package for this job: Health System Specialist Total Compensation | Pay (ihs.gov) Serves as the facility or provider authorized organizational official to review and complete CMS, state Medicaid, private insurance, and managed care applications. Submits with administrative approval. Serves as the liaison/ facility point of contact for the National Provider Identifier (NPI) and Provider Enrollment, Chain of Ownership System (PECOS) for all medical staff. Initiates, revalidates, or re-enrolls provider or facility applications for CMS, state Medicaid programs (Arizona, California, Nevada, and New Mexico). Includes but not limited to obtaining all necessary documentation to complete an application(credentialing information, medical license(s), etc.), obtain signatures and submit. Assists with the collection of data for the CMS Merit-based Incentive Payment System (MIPS) program as defined by CMS for eligible professionals and hospitals. Assists the facility and providers in adding or updating information for National Plan and Provider Enumeration System (NPPES, Medicare - Provider Enrollment, Chain and Ownership System (PECOS), Arizona AHCCCS incentive payment system (e-PIP), and CMS Identify & Access Management System (l&A). Analyzes and evaluates (on a quantitative or qualitative basis) the effectiveness of program operations in meeting established goals and objectives for provider enrollment, reporting requirements and timeliness of organizational responses and performance reporting. 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. BASIC REQUIREMENT(S): 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; OR Specialized Experience (for positions above GS-5): 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. Special Provision for Inservice Placement: Successful complete of an agency-sponsored on-the-job training program may be substituted for qualifying experience, provided it included a formal individualized training plan. Such a training program must have been conducted in an operating health care system and included: Assignments providing a knowledge of basic health system administration philosophies, practices, and procedures, and basic government administrative policies and requirements; Practical assignments providing an opportunity to apply health system administration skills and principles (as the individual progresses, work assignments must be characteristic of the grade level to which he or she is assigned); and Oversight by an experienced health system administrator with periodic evaluation of the individual's progress and appropriate adjustment of the training program. In addition, to the Individual Occupation Requirements, you must also meet the Minimum Qualifications stated below. MINIMUM QUALIFICATIONS - GS-9: 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: responsible for the evaluation and reporting and performs liaison functions with providers, state and local agencies, and business office personnel; Served as a facility or provider authorized organizational official to review and complete CMS, state Medicaid, private insurance, and managed care applications; Assists and supports medical staff to complete state Medicaid attestation and enrollment process; Analyzes and evaluates (on a quantitative or qualitative basis) the effectiveness of program operations. OR; Master's degree or equivalent degree that included the major study in hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration OR; Completion of two full years of progressively higher-level graduate education leading to such a degree that included major study - hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. OR LL.B. or J.D., if related, that included major study -- hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. OR Possess a combination of education and experience that when combined fully meet the minimum qualifications for this position. The total percentage equals at least 100 percent to qualify for this GS-09 grade level. 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. View the full announcement and apply on USAJOBS.gov.