Summary This position is located within the Community Care service of the Washington, DC, VA Medical Center. It is a highly complex multi-divisional tertiary care, extended care, & teaching medical center. Community Care is a comprehensive program responsible for the administrative and daily operational management of non-VA authorized and unauthorized medical care. Also performs important financial & program oversight, cost estimation, budget formulation, payment audits, claims, and payment processing. Responsibilities This is a developmental position in the Community Care service at the Washington, DC, VA Medical Center that forms part of a career ladder leading to the full performance level of Program Specialist, GS-0301-09. 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. MAJOR DUTIES AND RESPONSIBILITIES Responsible for all tasks involved in managing obligation fund control points and ensuring all activities are recorded in a timely, accurately, and balances are reconciled. Reviews and analyzes community care authorizations and payments within several software portals, including but not limited to FBCS, FMS, Vista, DOMA, VSSC, Carepoint, and SharePoint. This will include analysis of DOD Exception and Payment Reviews. Assures the development of data and long-term budget formulation. Gathers and analyzes financial data concerning the current and future state of program operations, including project costs based on current trends and review of historical data. Forecasts shortfalls/excesses within the program and proposes actions to accommodate those changes. Projects costs, analyzes workload, and trends for possible adjustment. Performs audits of payments made, ensuring accuracy; provides tracking to confirm corrections are made, and bills of collection are issued when appropriate. Responsible for establishing and updating, at the Austin Automation Center, vendor information (process known as vendorizing) to include social and demographic data, medical specialty code, and tax identification numbers for all NVCC/Fee programs (non-VA hospitalization, outpatient medical, dental, dialysis, and pharmacy). Exercises initiative and resourcefulness in researching and implementing new methods of planning for and estimating budgetary needs. Assist in management on all aspects of the interpretation and application of agency guidelines for the budget execution process to the program. Exercises tact, discretion, and judgment in making budgetary commitments within the program. Researches claims and payments questions from community providers and Veterans. Analyzes authorizations and claims issues to provide guidance to Community Care staff, Veterans, and community providers. Serves as service level subject matter expert on billing, claims, and payment for education and training of Community Care staff. Incumbent serves as a reasonable layperson in the review of medical records for the determination of medical and administrative entitlement under the Millennium bill. Coordinates the State Home program, a critical, highly visible program that includes contracts for our 560 veterans living in community nursing homes. Tracks veteran movement throughout community nursing homes and assisted living. Responsible for determining the appropriate billing rate based on the veteran's eligibility and for processing State Home applications within 10 calendar days. Serve as a subject matter expert to answer veteran and provider questions regarding billing and payment, including by phone, by secure message, by email, and in response to PATS-R and EV complaints. Perform other duties as assigned. Work Schedule: 8:00 am - 4:30 pm, Monday - Friday Virtual: This is not a virtual position. Position Description/PD#: Program Specialist/PD21033-O and PD21034-O Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized 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. Selective Service Registration is required for males born after 12/31/1959 Physical Requirements: The work required does not inherently include any physical requirements essential for successful job performance that could not otherwise be performed with accommodation or workplace adjustment. A pre-placement physical examination is not required. 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 identification 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) As a condition of employment for accepting this position, you will be required to serve a 1-year probationary period or 2-year trial 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 the 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 period, 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, applicants must meet all requirements by the closing date of this announcement 03/23/2026. 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-05. For a GS-09 position, you must have served 52 weeks at the GS-07. 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. You may qualify based on your experience and/or education as described below: GS-07 minimum qualifications: Specialized Experience: One (1) full year of specialized experience equivalent to the GS-05 in the Federal Service, that is directly related to the work of the position and has equipped me with the particular knowledge, skills, and abilities to successfully perform the duties as a Program Specialist. Specialized experience includes administrative daily operational management of non-VA authorized and unauthorized medical care, performing important financial and program oversight duties with respect to fund control point management, cost estimations for Community Care, budget formulation, payment audits, coordination with VISN and Payment Operations Management (POM) on budget, claims, and payment, and coordination of the State Home. OR, Education: One (1) full year of graduate-level education OR superior academic achievement. Education at the graduate level must be obtained in an accredited college or university and must demonstrate the knowledge, skills, and abilities necessary to do the work of this position. Superior Academic Achievement (SAA): SAA at the baccalaureate level in the coursework detailed above is fully qualifying. Applicants who wish to apply under this provision must submit proof from their educational institution that they meet one of the criteria listed below. To qualify for SAA, applicants must have completed all the requirements for a bachelor's degree in a curriculum that is qualifying for the position to be filled and meet one of the following: Rank in the upper one-third of your class in the college, university, or major subdivision. A grade-point average of "B" (a GPA of 2.95 or higher out of a possible 4.0) for all completed undergraduate courses, or those completed in the last two years of undergraduate study. A grade point average of "B+" (a GPA of 3.45 or higher out of a possible 4.0) for all courses in your major field of study, or those courses in your major completed in the last two years of undergraduate study. Membership in a national honor society (other than freshman honor societies) recognized by the Association of College Honor Societies. For a list of recognized honor societies, please visit http://www.achsnatl.org/quick_link.asp. For more information regarding SAA, please visit http://www.opm.gov/qua1ifications/SEC-ll/s2- e5.asp#e4f. OR, Combination: An equivalent combination of successfully completed graduate-level education and specialized experience, as described above, to meet the total requirements. The education portion must include graduate courses that demonstrate the knowledge, skills, and abilities necessary to do the work of this position. Only education beyond a bachelor's degree may be used to qualify applicants for the GS-07 level. This education must have been obtained in an accredited college or university. GS-09 minimum qualifications: Specialized Experience: One (1) full year of specialized experience equivalent to at least the next lower grade level (GS-07) in the Federal Service, that is directly related to the work of the position and has equipped me with the particular knowledge, skills, and abilities to successfully perform the duties as a Program Specialist. Specialized experience includes administrative daily operational management of non-VA authorized and unauthorized medical care, performing important financial and program oversight duties with respect to fund control point management, cost estimations for Community Care, budget formulation, payment audits, coordination with VISN and Payment Operations Management (POM) on budget, claims, and payment, and coordination of the State Home. OR Education: Successfully completed a master's or equivalent graduate degree OR 2 full years of progressively higher-level graduate education leading to such a degree OR LL.B. or J.D., if related, in a related field that demonstrates the knowledge, skills, and abilities necessary to do the work of this position. OR Combination: An equivalent combination of successfully completed graduate-level education (in excess of the first year or 18 semester hours) and specialized experience, as described above, to meet the total requirements. The education portion must include graduate courses that demonstrate the knowledge, skills, and abilities necessary to do the work of this position. Physical Requirements & Work Environment: The work involved is primarily sedentary in nature. Some walking, standing, bending, and carrying of lightweight items are involved in the hand delivery and pickup of documents and files. Mental concentration and sustained performance under prolonged stress are required due to the complexity and time-sensitive nature of work. Work is performed in an office setting. The employee may occasionally be exposed to communicable diseases and to patients who are mentally or emotionally/psychologically disturbed. 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 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: https://sites.ed.gov/international/recognition-of-foreign-qualifications/. Additional Information OUR MISSION: "Whole Health is an approach to health care that empowers and equips people to take charge of their health and well-being and live their life to the fullest. The VA is committed to Whole Health and values Veteran and Employee health and well-being. As a VA employee, you will practice Whole Health in an environment that supports personalized and proactive care." 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. 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 an 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. VA may offer newly appointed Federal employees 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. 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 qualified, you must submit appropriate documentation (a copy of the agency notice, your most recent performance rating, and your most recent SF-50 noting current position, grade level, and duty location) and be found well-qualified for this vacancy. To be well-qualified: applicants must possess experience that exceeds the minimum qualifications of the position including all selective factors, and who are proficient in most of the required competencies of the job. 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/.
