Summary These positions serve as Medical Reimbursement Technicians within the North East Consolidated Patient Account Center (CPAC). The position is responsible for performing a broad range of duties to achieve the established Office of Community Care (OCC)/CPAC expected results for medical billings and reimbursable and non-reimbursable collections. The position may also perform insurance verification duties. Responsibilities THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION This position involves a multi-grade career ladder. The major duties listed below represent the full performance level of GS-6. At the GS-5 grade level, you will perform assignments of a more limited scope and with less independence. You will progressively acquire the background necessary to perform at the full performance level of GS-6. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher-level work, and availability of funds. Major duties and responsibilities include: Validating claims for billing purposes ensuring eligibility and referring questionable coding for review. Submitting claims to third party health insurance carriers, with knowledge of Medicare coverage benefits. Interpreting third party insurance policies and requirements for billing. Taking responsibility for Medicare reimbursable billing activities. Following instructions about timeliness, objectives, and relative priorities for doing work. Handling conflicting goals, objectives, priorities, timelines, and deadlines. Exhibiting flexibility in adapting to changing demands within specific timelines. Accepting and completing work provided by a standardized control system such as batched work, caseload level, or other defined structure. Using a wide range of office software applications such as Microsoft Access, Excel, and Word. Composing correspondence on a situational basis. Processing billings using ICD-9-MC, CPT/4, and HCPCS codes timely. Performing other duties assigned as it relates to the position. Work Schedule: Monday-Friday, 8:00am to 4:30pm Recruitment & Relocation Incentives: Not authorized Critical Skills Incentive (CSI): Not approved 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 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 IN ORDER TO QUALIFY FOR THIS POSITION AT THE GS-5 LEVEL YOU MUST MEET THE FOLLOWING: GS-5 SPECIALIZED EXPERIENCE: You must possess at least one (1) full year of specialized experience equivalent to at least the next lower grade level (GS-4) in the Federal Service that has given you the knowledge, skills and abilities required to successfully perform the duties of a Medical Reimbursement Technician. Specialized experience includes following instructions about timeliness, objectives, and relative priorities for doing administrative work; communicating with other staff as necessary to discuss administrative concerns; reviewing and determining the appropriateness of administrative data. (THIS EXPERIENCE MUST BE SUPPORTED BY YOUR RESUME TO BE CREDITABLE.) ~OR~ GS-5 EDUCATION SUBSTITUTION: You must have successfully completed four (4) years of education above the high school level in any field which high school graduation or the equivalent is the normal prerequisite. This education must have been obtained in an accredited business, secretarial or technical school, junior college, college, or university. One year of full-time academic study is defined as 30 semester hours, 45 quarter hours, or the equivalent in a college or university, or at least 20 hours of classroom instruction per week for approximately 36 weeks in a business, secretarial, or technical school. (COPY OF TRANSCRIPTS ARE REQUIRED AT TIME OF APPLICATION) ~OR~ GS-5 COMBINATION: You must possess equivalent combinations of successfully completed post-high school education (beyond the second year) and specialized experience, as described above, which meet the total experience requirements for this grade level. This education must have been obtained in an accredited business, secretarial or technical school, junior college, college, or university. (THIS EXPERIENCE MUST BE SUPPORTED BY YOUR RESUME TO BE CREDITABLE AND COPY OF TRANSCRIPTS ARE REQUIRED AT TIME OF APPLICATION) IN ORDER TO QUALIFY FOR THIS POSITION AT THE GS-6 LEVEL YOU MUST MEET THE FOLLOWING: GS-6 SPECIALIZED EXPERIENCE: You must have at least one (1) full year of specialized experience equivalent to the next lower grade level (GS-5) in Federal service that has equipped you with the particular knowledge, skills, and abilities to perform successfully the duties of the position, and that is typically in or related to the work of the Medical Reimbursement Technician. Specialized experience includes following instructions about timeliness, objectives, and relative priorities for doing administrative work; communicating with other staff as necessary to discuss administrative concerns; reviewing and determining the appropriateness of administrative data; verifying claims for billing purposes ensuring eligibility and referring questionable coding for review and interpreting insurance policies and requirements for billing. (THIS EXPERIENCE MUST BE SUPPORTED BY YOUR RESUME TO BE CREDITABLE.) You will be rated on the following Competencies as part of the assessment questionnaire for this position: Customer Service (Clerical/Technical) Decision Making Manages and Organizes Information Self-Management Technical Competence IMPORTANT: A full year of work is considered to be 35-40 hours of work per week. All experience listed on your resume must include the month and year start/end dates. 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. 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; religious; 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. Physical Requirements: The work may require some physical effort such as periods of standing, walking, or bending. There are no special physical demands. The work is performed in a office setting that involves everyday risks or discomforts. Normal safety precautions are required. 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 IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on 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. For further information, visit: Recognition of Foreign Qualifications | International Affairs Office (ed.gov). 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.
