Summary This position is located in the Business Office, Eligibility/Intake Section. The purpose of the position is to serve as a Health Benefits Advisor, to the Business Office. The incumbent 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 Typical duties include but are not limited to the following: Eligibility and Enrollment 25%: Performs technical activities involved with screening, processing, and assisting veterans, nonveterans, and beneficiaries seeking multiple medical treatments. Interprets and fully understands all eligibility to make initial determinations whether Veterans or non-Veterans meet legal/contractual requirements for medical care. Familiar with government documents, such as DD-214s, to help make such determinations where no documentation exists, he/she is skilled and knowledgeable on how and where to initiate a timely search to obtain necessary documentation. Advises patients on National VA Enrollment, the Uniform Benefits Package, and non-medical benefits. Obtains all key information needed, including but not limited to complete and accurate demographic information, health insurance information, worker's compensation information, etc. Initiates and completes all administrative processing of requests and forms, including but not limited to, applications for care, financial statements, means tests, copay tests, etc. Accurately generates patient data cards for Veteran applying for care using the Veterans Health Identification Card (VHIC) system. Provides on-the-job training to new Health Benefits Advisors. Help develop functional processes and Standard Operating Procedures (SOPs). Customer Service, Teamwork, Communication 25%: Provide exceptional customer service by exceeding the customer's expectations. Incumbent interacts with a wide range of individuals, with varying degrees of understanding. Counsels Veterans and/or their representatives when adverse decisions are made. Compiles data and information necessary to respond to Congressional, patient, and attorney requests. Responds to inquiries on inpatient/outpatient programs at the local site, as well as at other facilities within the Network area. Handles suicide calls received from Veterans in an appropriate and sensitive manner following national, VISN and facility protocol. Signals co-worker to obtain clinical provider, maintains veteran on-line interacting through approved guidelines until provider arrives to take contact. Program Support 20%: Investigates discrepancies and affects resolution of problems through collaborative measures between our facility, other VA medical centers and Austin as necessary. Participates in quality improvement, team planning, strategy development, problem solving, and data validation activities which include analysis of information. Confidentiality and Security 15%: Regular and recurring contact with personnel external to the agency for the obtainment of services, sharing or information and authorization, clarification or denial of payment. Determining Beneficiary Travel Eligibility 10%: Responsible for gathering, entering and updating demographic, employment, insurance and income (means test) information into VISTA. Provides claims development for all @types of eligibility requests for inpatient and outpatient treatment as well as other special programs (i.e. Prosthetics, Dental Services, Nursing Home Care, Humanitarian, CHAMPVA, DoD Sharing Agreement activities, and non-DoD sharing agreements and/or contracts. Assists in orienting and educating clinical and administrative staff, in VA regulations, policies, and procedures on VA National Enrollment and the Uniform Benefits Package, as well as Consolidated Patient Account Center (CPAC), encounter forms and processing of workload. Clinic Scheduling 5%: Interpret and communicate requirements of VHA Scheduling Directives and complete accurate scheduling responsibilities to include PACT. Making and checkout of appointments, monitoring and correction of encounter data, answering telephones, etc following all established procedures and protocols. Perform other duties as assigned. Work Schedule: Monday-Friday 7:30am-4:00pm Virtual: This is not a virtual position. Position Description/PD#: Health Benefits Assistant/PD636D-30474-A Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized The VA Midwest Health Care Network advocates for a Whole Health System of care in each of the Medical Centers. This is an approach to healthcare that empowers and equips people to take charge of their health and well-being and live their lives to the fullest. As an employee operating in a Whole Health System of care, you will operate in a model with three core elements, seeking to create a personalized health plan for each Veteran. This is done in the @context of healing relationships and healing environments and a connection back to the Veteran's community. This aligns with the Veterans Health Administration (VHA) Mission Statement to Honor America's Veterans by providing exceptional health care that improves their health and well-being. 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 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, 06/05/2026. Time-In-Grade Requirement: Advancement to positions up to GS-05 Candidates may be advanced without time restriction to positions up to GS-05 if the position to be filled is no more than two grades above the lowest grade the employee held within the preceding 52 weeks under his or her latest non temporary competitive appointment. The grade may have been in any occupation, but must have been held in the Federal service. If applicable an SF-50 must be submitted with your application materials. 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: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-04 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Enter and update data such as demographics, insurance, and income into computerized databases; Prepare correspondence to address complex inquiries from internal and external customers; Monitor and update databases to maintain accurate health enrollment records; Provide guidance and clarification on enrollment and eligibility issues. OR, Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have successfully completed four (4) years of education above the high school level. NOTE: This education can be in any field for which high school graduation or the equivalent is the normal prerequisite and 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. OR, Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education (beyond the second year) and specialized experience as described above, which meet the total experience requirements for this grade level. NOTE: Transcripts (unofficial or official) must be submitted with your application materials. Education cannot be credited without documentation. Experience must be clearly indicated in your resume. 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/. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), your responses on the application questionnaire, and your responses to all assessments required for this position. You will be assessed on the following Competencies for this position: Accountability Analysis and Problem Solving Attention to Detail Computer Skills Customer Service Customer Service (Clerical/Technical) Decision Making Flexibility Integrity/Honesty Interpersonal Skills Learning Reading Comprehension Reasoning Self-Management Stress Tolerance Teamwork 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 Physical Demands: Work is performed in an area responsible for treating patients with a wide variety of medical problems including psychiatric or substance abuse. Occasionally Veterans may be angry and potentially violent. The incumbent is frequently exposed to communicable diseases. Safety precautions are sometimes necessary. Work requires no special physical demands, but will require some physical effort such as standing, walking, bending, and sitting. Work Environment: The work is normally performed in an office setting with occasional visits to clinical areas and other services. The work area typically is adequately lighted, heated, and ventilated although the area can be congested. Must be able to work under adverse situations and function at an optimum level of concentration in an environment with frequent interruptions and many activities in progress simultaneously. The incumbent works directly with the public, clerical and professional staff of the Medical Center. The incumbent observes established safety standards and practices as defined in the current Medical Center policy. Incumbent occasionally will attend meetings and obligations at other locations. 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 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. 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.
