U.S. Customs and Border Protection Program Analyst (O-4 Billet) Non-Supervisory

This U.S. Customs and Border Protection Program Analyst (O-4 Billet) Non-Supervisory position is with Immigration and Customs Enforcement (Department of Homeland Security) in Phoenix, AZ. Serves as a Claims Management and CBP Program Analyst supporting IHSC medical claims operations, MedPAR/referral review, claims adjudication, provider network enrollment, and denied claims resolution. Coordinates with CBP, ICE ERO, TPA, and community providers to ensure timely, compliant access to reimbursable healthcare services. This position is only open to USPHS officers and Call to Active Duty (CAD) candidates. Key duties: • DUTIES AND RESPONSIBILITIES: Serves in the capacity of a U.S. CBP Program Analyst (CBP PA); represents CMP and assists in program activities, and policies related to CBP's Office of Field Operations (OFO) and Homeland Security Investigations (HSI), medical payment authorization request application system (MedPAR2), claims adjudication, and provider recruitment with the goal of becoming a subject matter expert. Assumes leadership role as acting CBP Program Analyst Lead (CBP PAL) when necessary. Serves as CMP representative between IHSC, third-party administrator, U.S. CBP components, and ICE ERO in CMP program related activities. 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. Provides oversight and consultation while reviewing, approving, denying, and adjudicating Medical Payment Authorization Requests (MedPAR)/referral for reimbursable healthcare services submitted by U.S. CBP, OFO, and HSI. Duties include assisting in day-to-day managing, assessing, planning, developing, implementing, and assigned duties. Completes recurring assignments with minimal instructions; however, objectives, priorities and deadlines are provided on new assignments. The incumbent selects his/her own methods and solves most normal problems arising during the course of work. Completed work is usually evaluated for technical soundness, appropriateness and conformity to professional standards and PHS requirements. Incumbent assists with program compliance 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 manages delegated assignments 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; and render a service of a moderately complex nature requiring a moderate amount of explanation and tact. Liaise regionally and nationally with applicable internal and external stakeholders (e.g., U.S. Customs and Border Protection, TPA) regarding medical claims processes, trainings, and principles. Assists with providing orientation and guidance to the respective U.S. CBP, ICE, custody, and medical staff members of facilities in which U.S. CBP and ICE aliens are held regarding ICE policies, reporting requirements, and applicable ICE detention standards. Provides consultation to U.S.CBP, ICE, and custody regarding Medical Payment Authorization Requests (MedPARs) for reimbursable health care services and medical claims review. Collaborates with the Claims Management Program to reconcile and resolve denied off-site community provider claims and appeals. Assist TPA in coordinating and obtaining information pertaining to referrals or eligibility in the alien tracking system. Provides consultation to U.S. CBP for recruitment and enrollment of off-site community providers into the IHSC provider network. Judgmental failure could seriously affect the social, physical, and economic well-being of one or more individuals. Failure may waste efforts and resources of others. Impact of error can cause serious delays in service of others. Travel may be required estimated 15%. Travel TDY as required. Perform other duties and responsibilities as assigned. Qualifications: PHYSICAL DEMANDS: Sitting and/or standing for extended periods of time [6-8 Hours]. Performing repeated bending motion. Average manual dexterity for computer operation. Phone use for extended periods of time. Required to walk unaided at a normal pace for up to 5 minutes and maintain balance. Required to jog/fast walk up to 1⁄4 mile. Required to perform CPR/emergency care standing or kneeling. Must have the ability to assist sick, injured, or aging illegal aliens or staff exiting the building (may require lifting, dragging, wheeling, or carrying someone who weighs significantly more than oneself). View the full announcement and apply on USAJOBS.gov.