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. This position 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 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-7. At the GS-6 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-7. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher-level work, and availability of funds. As a Health Benefits Contact Representative, the incumbent serves as the subject-matter expert and is responsible for applying an extensive body of rules and regulations relative to Veterans Eligibility for Veterans Affairs (VA) healthcare benefits, interpretation of relevant laws, Veterans Health Administration (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, into the Vista and Veteran Enrollment System (VES). Adjudicating and authorizing Veteran's eligibility applications for programs such as, but not limited to, enrollment, eligibility for Veterans Affairs (VA) healthcare benefits, and financial assessment. Determining entitlement to medical care as well as bill preparation and collection on all billable episodes of inpatient and outpatient care. Ensuring accurate and complete data collection is essential to proper processing of third-party collection requirements as mandated by law. Serving as expert benefit representative to Health Administration Service (HAS) Leadership and support the management information components of all health eligibility related programs. Entering data and information when necessary, but also reviewing of reports, records and statistical computations for accuracy and propriety. Developing financial assessments to determine the veteran's priority for enrollment in the Veterans Affairs (VA) Healthcare System and their eligibility for income-based benefits. Counseling veterans and their representatives regarding the outcome of the case development process to ensure that eligibility for Veterans Affairs (VA) benefits and services are thoroughly explained, including assistance of resolution with Internal Revenue Service/Social Security Administration Income Verification Audits. Adjudicating cases that meet Veterans Affairs (VA) hardship determination criteria for Enrollment of Rejected Veterans / Patients required to pay co-pays for care at the time of initial registrations/ Health Benefit Updates and instructs the veteran on the income/ medical expense information required on the VA Form 10-10HS to determine eligibility. Performing other related duties as assigned. Work Schedule: Monday through Friday; 8:00am-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 To be considered for this position, you must complete all required steps in the process. In addition to the application and questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job. All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA. Selective Service Registration is required for males born after 12/31/1959 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) - See "Required Documents" below for details. As a condition of employment for accepting this position, you will be required to serve a 1-year probationary period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider: your performance and conduct; the needs and interests of the agency; whether your continued employment would advance organizational goals of the agency or the Government; and whether your continued employment would advance the efficiency of the Federal service. Upon completion of your probationary, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest. Qualifications To qualify for this position at the GS-6 level, you must meet the following requirement: Experience: For the GS-6 grade level you must possess at least one (1) full year of specialized experience that has equipped you with the knowledge, skills, and abilities to perform the duties of the position, GS-6 as described below. To be creditable, this experience must have been equivalent to at least the GS-5 grade level in the Federal Service. Specialized experience includes: providing customer service support, receiving inbound and making outbound telephone calls with multiple customers; receiving and reviewing benefit applications; preparing correspondence; and processing requests to update customer/patient information in a computerized database. NOTE: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week. Physical Demands: 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. Work Environment: Works in an office/clinical setting. Work areas are generally adequate and shared. Occasional travel is required. He/she frequently walks to and interacts with other services throughout the facility and Community Based Outpatient Clinics. The incumbent observes established safety standards and practices as defined in the facility's policies and guidelines. May also occasionally work outside the Veterans Affairs (VA) to participate in community events such as Health Fairs, Homeless Veterans Stand Downs and Post Deployment Health Re-assessment (PDHRA). 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. 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. 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: https://sites.ed.gov/international/recognition-of-foreign-qualifications/. Additional Information Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments. 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. Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. 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. 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. The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced Federal competitive service employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit appropriate documentation and be found well-qualified (have a final rating of 80 or more before any Veterans preference points) for this vacancy. Information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/. Note: Per "Executive Order 14251: Exclusions from Federal Labor-Management Relations Programs", this position is no longer eligible for bargaining unit participation.
