Summary The purpose of the position is to serve as a Health Benefits Unit Contact Representative, to the Health Administration Service (HAS), under the direct supervision of the Supervisory Medical Administrative Specialist. The incumbent is responsible for a wide range of assignments and provides administrative support to the Section, and the cost recovery aspects of this position have a direct impact on the reimbursement of the facility. Responsibilities Health Benefits Contact Representative Serves as the subject-matter expert and is responsible for applying an extensive body of rules and regulations relative to Veterans Eligibility for VA healthcare benefits, interpretation of relevant laws, VHA guidelines and regulations, and other federal agency policies is required to ensure that timely and appropriate measures are taken throughout data collection and data entry processes. Processing requests to update veterans personal, eligibility and enrollment information, entering demographic, insurance, and income information. Serves as a base for determining entitlement to medical care as well as bill preparation and collection on all billable episodes of inpatient and outpatient care. Accurate and complete data collection is essential to proper processing of third-party collection requirements as mandated by law. Serve as expert benefit representative to HAS Leadership and support the management information components of all health eligibility related programs. Provides administrative support and collaborates with inpatient staffing personnel such as Physicians, Physician's Assistants, Nurses, Advanced Registered Nurse Practitioners, Dietitians, Social Workers, and other administrative and professional staff throughout AAVAMC area transitioning patients identified as ineligible for VA patient care. Accurately generates patient data cards for veterans through the Identity Management Toolkit for proofing identity and the Veterans Health Identification Card (VHIC) System. Monitors enrolled patient data base information on a regular basis (at a minimum, annually) to perform updates to health insurance data, income assessments for the Means Test and Pharmacy Co-pay Exemption programs as mandated by law. Correspondence Prepares written correspondence for a broad spectrum of complex inquiries from intel and external customers by independently recognizing issues, topics, or problems. Prepares, composes, and reviews correspondence prepared for the purpose of obtaining or supplying information. Resolves conflicting or inconsistent information by dealing with various VA offices, sorting out errors and researching past transactions, cases or events. Consult Coordination/New Enrollment Appointment Request (NEAR) List Managing the NEAR list and electronic wait list to verify and validate accuracy and resolve issues; providing input during team meetings and to assist in resolving problems having to do with enrollment issues, or panel assignments. Generates and monitors enrolled patient data base information for accurate health insurance data Customer Service Provide exceptional customer service by exceeding the customer's expectations Actively listen to customers with respect and concern; the incumbent will pay attention to the details of the customer's needs and help the customer arrive at a satisfactory solution to the problem Communicates and interacts with patients in a manner which is appropriate to cognitive, emotional, and chronological maturation needs of the adult and/or geriatric patient. Perform all other related duties as assigned. Promotion Potential: The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met. Selection at a lower grade level does not guarantee promotion to the full performance level. Work Schedule: Monday-Friday 8:00am to 4:30pm Position Description/PD#: Contact Representative/PD92689-A 92690-A Financial Disclosure Report: Not Required Requirements Conditions of Employment You must be a U.S. Citizen to apply for this job Selective Service Registration is required for males born after 12/31/1959 You may be required to serve a probationary/trial period Subject to background/security investigation Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued dentification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP) Qualifications To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 08/28/2025. Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-07 position, you must have served 52 weeks at the GS-06 For a GS-06 position, you must have served 52 weeks at the GS 05 The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment. Applicants must be eligible under the VA Interchange Agreement, having served continuously for at least one year in the other merit system under this interchange agreement. For more information regarding the VA Interchange Agreement please visit: https://www.opm.gov/policy-data-oversight/hiring-authorities/competitive-hiring/. - All Title 38 Veterans Canteen Service (VCS) employees must have served in their Excepted Service position for at least 90 days in order to be eligible for a position within the Competitive Service. - Applicants who were previously selected under a Competitive Delegating Examining Unit (DEU) announcement must have served in their position for at least 90 days prior to being eligible for other positions within the Competitive Service. You may qualify based on your experience as described below: Specialized Experience: GS-07: You must have one year of specialized experience equivalent to at least the next lower grade GS-06 in the normal line of progression for the occupation in the organization. GS-06: You must have one year of specialized experience equivalent to at least the next lower grade GS-05 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but is not limited to: Perform interrelated and nonstandard legal support work; examine documents where the information and facts are: straightforward and readily verifiable; need little development; require limited searches of reference, file, or historical material; and entail comparisons with explicit criteria; plan, coordinate, and/or resolve problems in support activities; use a wide range of office software applications to prepare complex documents containing tables or graphs; and use online legal resources to obtain information accessible over the Internet, as needed. Perform assistance work requiring extensive searches of records, reference, or historical material and comparisons with complex, voluminous, or broadly written criteria; use specialized, complicated techniques to complete assignments, such as comparing options or identifying conflicts; develop, examine, adjust, reconsider, or authorize settlements; and assist higher grade employees to plan strategies. Knowledge of beneficiary travel rules and regulations regarding legal entitlement to travel reimbursement Skill in using a calculator to accurately compute mathematical equations for income assessments, etc. You will be rated on the following Competencies for this position: Analytical Reasoning Attention to Detail Computer Skills Customer Service Oral Communication 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; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Note: A full year of work is considered to be 35-40 hours of work per week. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. Physical Requirements: This is primarily a sedentary position, but the work requires some walking, bending, stooping and carrying of light objects such as manuals, documents, etc. Concentration and sustained performance under prolonged stress is required because of the time factors involved in completion of work assignments within deadlines. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/. Education There is no educational substitution at this grade level. Additional Information This job opportunity announcement may be used to fill additional vacancies. If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement. Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act.
