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

Summary

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.

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).

Education

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES: Incumbent must possess a bachelor's degree in healthcare-related field with 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 management, administration, or evaluation of public health programs. Healthcare management, finance or medical claims is preferred. 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 within the scope of their clinical license in times of critical needs within the agency. Basic 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 and 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 MS Office applications and Adobe. How You Will Be Evaluated

We will review your resume and supporting documentation to ensure you meet the minimum qualification requirements. You may be selected for an interview at the hiring authority's discretion. You will be notified of selection or non-selection. Other Information

This is a U.S. Public Health Service position located within the Department of Homeland Security (DHS), Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO), ICE Health Service Corps (IHSC), Healthcare Compliance Division, Health Plan Management Unit (HPMU), Claims Management Program (CMP). The incumbent reports directly to the CMP's CBP Analyst Lead (CBP AL). This is a non- supervisory position. The HPMU Claims Management Program (CMP) manages national operations of a provider network, claims adjudication processes and IHSC's claim processing third-party administrator (TPA). The CMP collaborates with the TPA claims processor, IHSC's Credentialing and Privileging Unit and off-site community providers to complete enrollment processes and establish letters of understanding with IHSC. CMP works jointly with internal and external stakeholders to meet mission initiatives, maintain a provider network and achieve timely adjudication of claims. IHSC is committed to providing the necessary medical intervention for aliens to reduce global disease and support the safe apprehension, enforcement and removal of aliens involved in immigration proceedings. IHSC has a multi-sector, multidisciplinary workforce of more than 1,600 employees, including U.S. Public Health Service (PHS) commissioned officers, federal civil servants, and contract staff. IHSC provides on-site direct patient care to ICE detainees at 17 detention facilities throughout the country and manages the provision of off-site medical care for detainees housed in approximately 240 additional Intergovernmental Service Agreement (IGSA) facilities. The ICE detainee population is approximately 34,000 on a daily basis, with an average length of stay of about 30 days, and over 400,000 detainees annually. IHSC Headquarters provides guidance and support to IHSC-staffed facilities. While IHSC does not directly provide medical services in non-IHSC-staffed facilities, IHSC audits the facilities' compliance with national detention standards, as required by each facility's contract with ICE. SUPERVISORY CONTROLS: The CBP Program Analyst works under the supervision of the CBP PAL. Assignments are usually of a long-term, recurring, or broadly defined nature. The incumbent 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.