Summary The incumbent serves as a Health Benefits Assistant located in the Patient Registration Department of the VA Pittsburgh Healthcare System. Organizationally, the HBA reports to the Supervisor of Patient Registration. The primary function of this position is to make eligibility determinations for VA healthcare. Responsibilities The major duties of the Health Benefit Assistant include but are not limited to: Screen, advise, and assist Veterans and other beneficiaries seeking and receiving medical treatment. Subject matter experts to the HAS Section Chiefs and support the management information components of all health eligibility related programs. Provides advice, problem resolution, and administrative support for eligibility issues related to healthcare services. Knowledge of pertinent laws, regulations, polices, guidelines and procedures is required. Entering data and information when necessary, but also reviewing reports, records and statistical computations for accuracy. Involved in an extremely complex blend of computing technology, medical information, communication skills and leadership qualities in a rapidly changing environment. He/she must possess vast computer knowledge in creating and capturing data. Interviews and registers applicants to determine eligibility and legal entitlement of applicants for health care, including assignment into the appropriate enrollment priority group. Verifies eligibility using various methods, including: income assessments, military discharge documents, Hospital Inquiry (HINQ), Veterans Benefits Management System (VBMS), Veteran Information Solutions (VIS) and other means such as communication with VA Regional Office. Administers income assessments (means tests). Advises and counsels Veterans and their beneficiaries or representatives of financial obligations, co-pay requirements, and their rights to appeal. Deals with and resolves complex eligibility, co-pay, and insurance questions that arise. Explains to each individual the specific conditions or actions that could affect their co-pay status or eligibility for benefits. Informs Veterans of their responsibility to report changes in their demographics, insurance, and other significant factors. Work Schedule: Monday through Friday, 8:00am to 4:30pm Position Description Title/PD#: Health Benefits Assistant/PD00046A Physical Requirements: The work is primarily a sedentary position. Typically, the employee sits comfortably to do the work. But, there may be some walking, standing, bending, carrying of light items such as papers, books, small items, etc. No special physical demands are required to perform the work. Concentration and sustained performance under potential stress of accuracy and deadlines is required because of factors involved in completion of various complex work assignments. Requirements Conditions of Employment Qualifications To qualify for this position, applicants must meet all requirements by the closing date of this announcement. GS-05 grade level: One year of specialized experience (equivalent to the GS-04 grade level in the federal service); experience that equipped the applicant with the particular knowledge, skills and abilities (KSA's) and other characteristics to perform successfully the duties of the position, and that is typically in or related to the work of the position to be filled, in the normal line of progression for the occupation in the organization. Specialized experience includes: Meets and greets customers to determine the specific need. Maintains adherence with all workplace security policies and regulations ensuring work completed done within established guidelines. Responds to customer requests and follow up. OR; Applicants may substitute education for the experience required for the GS-05 level. To qualify based on education for this grade level you must have 4 years above high school. (Transcripts Required) OR; Applicants may also combine education and experience to qualify at the GS-05 level. To calculate, first identify the percentage of required education you have earned (when substituting, you cannot use the first 60 semester hours that you earned). Then identify the percentage of required experience you possess. Add the two percentages. The total percentage must equal at least 100 percent to qualify at the GS-05. For example, an applicant who has 9 semester hours of graduate level education (i.e. 50% of graduate education required) and 6 months of creditable specialized experience (i.e. 50% of the required experience) would equal 100% of the required experience for the position A transcript must be submitted with your application if you are basing all or part of your qualifications on education. You will be rated on the following Competencies for this position: Analysis and Problem Solving Customer Service (Clerical/Technical) Manages and Organizes Information Standards Technical Competence 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. Preferred Experience: Proficient in Microsoft Office Suite, experience with electronic medical records systems, experience in customer service for high volume patients. Education Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/.If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. Additional Information 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. Participation in the seasonal influenza program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). It is a requirement that all HCP to receive annual seasonal influenza vaccination or obtain an exemption for medical or religious reasons. Wearing a face mask is required when an exemption to the influenza vaccination has been granted. HCP in violation of this directive may face disciplinary action up to and including removal from federal service. HCP are individuals who, during the influenza season, work in VHA locations or who come into contact with VA patients or other HCP as part of their duties. VHA locations include, but are not limited to, VA hospitals and associated clinics, community living centers (CLCs), community-based outpatient clinics (CBOCs), domiciliary units, Vet centers and VA-leased medical facilities. HCP include all VA licensed and unlicensed, clinical and administrative, remote and onsite, paid and without compensation, full- and part-time employees, intermittent employees, fee basis employees, VA contractors, researchers, volunteers and health professions trainees (HPTs) who are expected to perform any or all of their work at these facilities. HPTs may be paid or unpaid and include residents, interns, fellows and students. HCP also includes VHA personnel providing home-based care to Veterans and drivers and other personnel whose duties put them in contact with patients outside VA medical facilities. The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced VA competitive service employees with selection priority over other candidates for competitive service vacancies. To be well-qualified, applicants must possess experience that exceeds the minimum qualifications of the position including all selective factors if applicable, and must be proficient in most of the requirements of the job. Information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website which can be found at https://www.opm.gov/. Receiving Service Credit for Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. VA may offer newly-appointed Federal employee's credit for their job-related non-federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed. 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.
