Duties
DUTIES AND RESPONSIBILITIES: 1. Assists HPMU senior leadership in overall responsibility for the successful planning, design, execution, monitoring, and management of Health Plan Management Unit activities. Assumes leadership role as Acting HPMU Chief or Deputy when necessary. The Claims Management Program Administrator (CMPA) has direct oversight of personnel, program activities and policies related to medical claims and provider recruitment. Responsible for providing first-line supervision and administrative oversight of the Supervisory Claims Management Program Analyst (CM RPAs), Supervisory IHSC CBP Program Analyst, IHSC CBP Program Analyst, CMP Analysts (CM PA), Provider Relations Liaisons (PRL) and a CMP Referral Coordinator (RC) that supports the CMP. Plans, schedules, and assigns work to be accomplished by subordinate claims management staff; determines and sets program policies and goals, initiates organizational changes, delegates authority to subordinate supervisors, and holds program supervisors responsible for the performance of their organizational components. Directs CMP of nationwide scope and importance. The CMP is essential to the mission of the ICE/ERO/IHSC and affects large numbers of people on a long-term or continuing basis. Directs, implements, creates, and manages preparation of program planning, design, execution, monitoring, and management of Claims Management (CM) initiatives and projects. Serves as Subject Matter Expert and representative for Claims Management Program with Data Analysis Office (DAO), Utilization Management Program, third party claims vendor, Field Medical Coordination Unit (FMCU), Health Information & Technology Unit (HITU) and IHSC's Executive Governing Board (EGB). As operational liaison, produces Claims Management data analysis reports for taskings related to data and legal cases against ICE (Immigration, Customs & Enforcement), U.S. Customs and Border Protection (CBP), Homeland Security Investigations (HSI), and CBP's Office of Field Operations (OFO) requested by OIG (Office of Inspector General), OPLA (Office of Policy Legal Advisors), CRCL (Civil Right & Civil Liberties), OSEC (Office of the Secretary), congressional & media inquiries related to CM. Serves as CM representative between IHSC, third party claims vendor , CBP components, and ICE ERO components in coordinating care and recruitment of community-based specialty care for noncitizens. . Develops, reviews, and revises national level directives, standard operating procedures, and guides for CMP Analyst, CBP CMP Analyst and Provider Network Programs. Provides oversight and consultation regarding Medical Payment Authorization Requests (MedPARs) for reimbursable health care services, medical claims review and systems. Liaise regionally and nationally with applicable internal and external stakeholders, including in other federal departments or outside the federal government, (e.g., Customs and Border Patrol, Office of Field Operations, Homeland Security Investigations and third-party claims vendor) regarding medical claims processes, trainings, and principles. This requires contact via teleconferences and/or telephone dialogue on a routine basis. Provides orientation and guidance to the respective ICE, custody, and medical staff members of facilities in which ICE noncitizens are held regarding ICE policies, reporting requirements, and applicable ICE detention standards. Serves as Claims Management Program lead for IHSC's third party claims vendor $100M+ Service Level Agreement (SLA) to include: certification of invoices, certification of funds availability, and approval of miscellaneous expenses. Liaises with IHSC staff, as one of the primary points of contact for the third-party claims vendor on issues relating to pharmacy benefits and claims, medical claims processing and resolution, and provider reimbursement. Coordinates and collaborates with internal and external stakeholders, including 5,000+ community providers, CBP stations/sectors, nonIHSC facilities and IHSC facilities to manage and adjudicate medical claims to meet the ICE/IHSC mission. Develops, evaluates, and coordinates a national level CMP and 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 ICE noncitizens. Develop and submit quarterly and annual reports, i.e. , Strategic Plan MAP/KPIs, training, Business Plan Updates, etc. to the HMP Unit Chief and Deputy Unit Chief. As a Government Technical Monitor (GTM), the incumbent works directly with the Contracting Officer Representatives (COR) with respect to contract staff performance, time, and compliance as needed. Performs other duties and responsibilities as assigned.
Requirements
Conditions of Employment
- You must be a U.S. citizen to apply for this position.
- You must successfully pass a background investigation.
- You must successfully pass a drug screen.
- Males born after 12/31/59 must certify registration with Selective Service.
- Requirements by Closing Date: Unless otherwise noted, you must meet all requirements by the closing date of the announcement.
- Service Remaining Requirement Agreement: Upon appointment to this position, officers will be required to serve a new 18-month commitment to IHSC .
- Applicants must be a current USPHS Commissioned Corps Officer who works at IHSC. USPHS Call to Active Duty (CAD) candidates are not eligible for this position. Civilians are not eligible for this position.
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 ¼ mile. Required to perform CPR/emergency care standing or kneeling. Must have the ability to assist sick, injured, or aging noncitizens 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 minimum of a bachelor's degree but graduate degree in Business Administration, Finance or Health Care Management or related field preferred; or a graduate degree with extensive experience in claims management, benefit, third-party administration, or contract management with a minimum 5 years of professional experience relevant to the officer's category. Of the total professional experience, officer must possess at least 4 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 current 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. Incumbent must possess at minimum, a Level II COR 40-hour course certificate or must obtain after one year of hire through the Defense Acquisition University (DAU) and Federal Acquisition (FAI) Cornerstone OnDemand (CSOD) online comprehensive learning platform. Three years of supervisory experience. Minimum of three-years' experience in correctional/detention health programs preferred. Able to obtain knowledge and maintain proficiency in, applicable IHSC policies and detention health care standards [i.e., ICE National Detention Standards and Performance Based National Detention Standards (PBNDS), National Commission on Correctional Healthcare (NCCHC), American Correctional Association (ACA) and Family Residential Standards (FRS)] Preferably a minimum of three years in an office now part of IHSC Knowledge of medical, administrative, ethical, and legal requirements and standards related to healthcare delivery, claims management and medical necessity. Possess basic 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 MS Office applications and Sharepoint. Project Management and/or Program Management experience preferred
Additional information
This is a U.S. Public Health Service position within the Department of Homeland Security (DHS), Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO), ICE Health Service Corps (IHSC), Office of Deputy Assistant Director for Healthcare Compliance, Office of Health Plan Management Unit (HPMU). The incumbent reports directly to the IHSC HPMU Deputy Chief. This is a supervisory position.
The incumbent administrates and is responsible for overall operations of the HPMU Claims Management Program (CMP). The CMP is a national level program and is essential for ICE noncitizen healthcare and the ICE/IHSC/HPMU mission. The CMP focus through the governance of a provider network, and claims adjudication. HPMU collaborates with the a thirdparty medical claims administrator, IHSC stakeholders and non-IHSC stakeholders [including U.S. Border and Protection (CBP)] and offsite providers to establish letters of understanding with IHSC. HPMU also works jointly with IHSC stakeholders (eg. pharmacy, dental, the Behavioral Health Unit, the Field Medical Coordination Unit) Department of Homeland Security (DHS) stakeholders and IHSC headquarters to meet mission initiatives. HPMU trains applicable stakeholders to improve processes related to the recruitment and retention of outside providers and claim process workflows to decrease claim denials and increase the number of paid claims.
In Fiscal Year (FY) 2024, IHSC provided direct care to more than 138,000 noncitizens housed in 18 facilities throughout the nation to include medical, dental, and mental health care, and public health services. In FY 2024, IHSC oversaw compliance with health-related standards for over 186,900 detained noncitizens housed in 129 non-IHSC-staffed facilities, totaling almost 45,500 beds.
SUPERVISORY CONTROLS:
The Claims Management Program Administrator works under the supervision of the IHSC HPMU Deputy Chief of the Health Plan Management Unit. Directs the IHSC CM program of nationwide scope and importance according to the IHSC mission. The incumbent plans, schedules, assigns and directs work; ensures adequate training of staff; exercises complete administrative control over subordinates; and carries out program policies.
- Benefits
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. Opens in a new windowLearn more about federal benefits .
Review our benefits
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.
How You Will Be Evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
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.
- Benefits
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. Opens in a new windowLearn more about federal benefits .
Review our benefits
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.
- Required Documents
As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have - whether you're a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you're eligible under their policies.
To apply for this position, you must provide a complete Application Package. Please note that if you do not provide all required information, as specified in this announcement, you may not be considered for this position.A complete application includes:
U. S. Public Health Service Officers - Cover Letter/Letter of Interest. Please include location preference here.
- Degrees. (Place under "Diploma/GED")
- Professional license. (If applicable)
- Additional professional certificates. (If applicable)
- Three professional references. (i.e., name, title and contact information)
- Official USPHS Promotion CV - e.g., relevant experience, education, training. (Place under "Resume")
- *Three most recent Commissioned Officer Effectiveness Reports (COER). (Place under "Performance Appraisal")
- A copy of your current Service Remaining Requirements Agreement.
- Indicate if you have an Assignment Pay (AP) Agreement and the date of the end of your AP Agreement.
If you are relying on your education to meet qualification requirements:
Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education .
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
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