Summary Employee will be assigned to the Consolidated Patient Account Center (CPAC), Chief Operating Officer (COO), Billing and Insurance Verification Department, Lebanon, PA, performing a broad range of duties to achieve the established and expected results for medical billing and reimbursable and non-reimbursable collections. 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. Duties include, but may not be limited to the following: Performs verification of patient insurance coverage. Obtains patient insurance information through automated databases, direct patient contact and contact with insurance companies. Verifies benefits, policy number, pre-certification requirements, and effective dates of coverage. Updates and maintains patient information in an electronic database. Generates monthly reports as required. Ensures that all billable cases are identified and that bills are accurately generated. Validates claims for billing purposes, ensuring eligibility, and referring questionable coding for review. Tracks, reviews, and corrects denials. Obtains required information and coordinates completion of forms with patients, staff, and providers. Responds to patients' questions, explaining eligibility requirements, insurance provisions, and billing and payment procedures. Performs third party collection from insurance companies and accounts receivable functions. Verifies the accuracy of payments, resolves problems and discrepancies, and closes out accounts. Performs other related duties as required. Work Schedule: Monday - Friday, 8:00am - 4:30pm. Recruitment & Relocation Incentives: Not authorized Telework: This position may be authorized for ad-hoc telework. Ad-hoc telework eligibility will be discussed during the interview process. 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 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 SPECIALIZED EXPERIENCE-GS5: Applicants must possess at least one (1) year of specialized experience that equipped them with the particular knowledge, skills, and abilities to perform successfully the duties of this position, and that is typically in or related to the work of this position. To be creditable, this experience must have been equivalent to at least the GS-4 level in the Federal service. Specialized experience includes: working in a medical billing environment for healthcare reimbursement and accounts receivables; verifying patient insurance coverage and eligibility; collecting from third party insurance companies; and coding actions utilizing International Classification of Diseases (ICD-9) and Current Procedural Terminology (CPT/4) diagnostic codes. OR SUBSTITUTION OF EDUCATION FOR EXPERIENCE (Transcript Required): Successful completion of (4) years of education above the high school level. This education must have been obtained in an accredited business, secretarial or technical school, junior college, college or university for which high school graduation or the equivalent is the normal prerequisite. One year of full-time undergraduate 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. OR COMBINING EDUCATION AND EXPERIENCE (Transcript Required): Combination of successfully completed post high school education and experience may be used to meet total qualification requirements. SPECIALIZED EXPERIENCE-GS6: Applicants must possess at least one (1) year of specialized experience that equipped them with the particular knowledge, skills, and abilities to perform successfully the duties of this position, and that is typically in or related to the work of this position. To be creditable, this experience must have been equivalent to at least the GS-5 level in the Federal service. Specialized experience includes: working in a medical billing environment for healthcare reimbursement and accounts receivables; verifying patient insurance coverage and eligibility; collecting from third party insurance companies; coding actions utilizing International Classification of Diseases (ICD-9) and Current Procedural Terminology (CPT/4) diagnostic codes; and auditing accounts. PHYSICAL REQUIREMENTS: The work may require some physical effort such as periods of standing, walking, or bending. There are no special physical demands. 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. There is no educational substitution at the GS6 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.
