Summary This position is in the Office of Community Care and reports to the designated Supervisory Health System Specialist (supervisor). The Specialist conducts reviews in the areas of community care coordination and claims related to care in the community to attempt to resolve concerns from Veterans and community providers. Conducts reviews as required by their direct supervisor and medical center leadership. Responsibilities Serves as the liaison between the patient/family, vendor, Veterans Board of Appeals, Congressional Liaisons, District Counsel, Veteran's Affairs Medical Centers, and the Office of Community Care and provides a channel through which the unit can respond to patients' needs and concerns. Identifies problems or answers questions about entitlement and services that can or cannot be provided; identifies sources of difficulty in obtaining services; negotiates VA "red tape" on behalf of the Veterans; makes appropriate referrals to other services within the VISN, Office of Community Care or community; provides follow-up to ensure that satisfactory service has been provided. Receives and hears complaints, grievances and other requests for information from Veterans or from individuals acting on behalf of the Veteran. Takes inquiries from Veterans, their family members, and/or representatives and uses research tools, assessment of data, and research modalities in order to get the data to support the response. Reproduces the research results or the supply of their results as necessary. Provides updates on progress of work completed and claims that are moved back into processing and appropriate payment is confirmed. Working knowledge of VistA, CPRS, JVL, Call Center Portal, Microsoft Word, Excel, Access, PowerPoint, Outlook corporate email account, all modules of FBCS and other related points of data tools in order to use for reporting, recording, and communication purposes. Coordinates and provides assistance and advice in the application of standards that affect the service. Plans and carries out projects to improve the efficiency and productivity of organizations and employees in administrative support activities. Identifies, analyzes, and makes recommendations to resolve conventional problems and situations. Gathers, analyzes, and prepares information while applying sound judgment when responding to inquiries to include those from Congressional Offices, White House Hotlines,VAIQs, CBI Helpline, Call Center Portals, Reports of Contact, and others as assigned appropriately managing relations across business units. Collaborates with Veterans and vendors regarding procedural, technical and/or operational functions within the Office of Community Care. Participates in the establishment of administrative qualitative standards intended to improveprograms, facilities and operations. Maintains a close working relationship with various program officials. Identifies the elements of the clinical or administrative practices that contribute to or create an atmosphere for patient/customer dissatisfaction and recommends changes that will reduce or eliminate complaints. 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. Work Schedule: Monday-Friday 8:00am-4:30pm Virtual: This is not a virtual position. Position Description/PD#: Customer Service Specialist/PD03641-A and PD03642-A 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. 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) 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, 06/23/2026. Time-In-Grade requirements also apply to former VA employees applying for reinstatement with CTAP eligibility. For a GS-7 position you must have served 52 weeks at the GS-5. For a GS-9 position you must have served 52 weeks at the GS-7. 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 VA employees applying for reinstatement with CTAP eligibility. You may qualify based on your experience and/or education as described below: GS-7 Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade (GS-5) in the normal line of progression for the occupation in the organization. Specialized Experience include (but are not limited to): Experience with insurance, claims, billing, congressional offices, and third party administrators. Experience in customer service/relations, educating patient/providers, and resolving issues. Technical Experience with Health Informatics associated with multiple computer software packages. Experience reporting to leadership, collecting data, data analysis, and building reports. Experience in the healthcare field, medical terminology, and chart reviews. OR, Education: Successfully completed one full year of graduate level education in a field related to this position that demonstrates the knowledge, skills, and abilities necessary to do the work of this position. Note: Transcripts are required. OR, Superior Academic Achievement: Completed all the requirements for a bachelor's degree in a curriculum that is qualifying for the position to be filled and I 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. Note: Transcripts are required. OR, Combination: Equivalent combination of successfully completed graduate education and specialized experience to meet the total experience requirements. The education portion must include graduate courses that demonstrates the knowledge, skills, and abilities necessary to do the work of the position. Only education beyond a bachelor's degree may be used to qualify for the GS-07 level. GS-9 Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade (GS-7) in the normal line of progression for the occupation in the organization. Specialized Experience include (but are not limited to): Experience with polices, precedents, goals, objectives, laws, VA guidelines related to the authorization and payment for care in the community sufficient to analyze and evaluate the continual changes in the program. Experience with health services research methods, including data collection and management methods, analysis design, interpretation of study results and translation of study results into action plans. Skilled in solving complex problems associated with the day-to-day operations concerning customer service issues in a positive, goal-oriented way, including the ability to take quick and effective action when necessary. Skilled in the use of research tools, assessment of data, establishment of effective research modalities and the maintenance of data for research for all inquiries. Utilizes available software and other data to provide a complete picture of research and the results. OR, Education: Successfully completed a Master's or equivalent, or 2 years of progressively higher level education leading to such a degree, or an LL.B or J.D.in a field related to this position that demonstrates the knowledge, skills, and abilities necessary to do the work of this position. Note: Transcripts are required. OR, Combination of Specialized Experience and Education: Equivalent combination of successfully completed graduate education and specialized experience (beyond the first graduate year or 18 semester hours) and specialized experience to meet the total experience requirements. The education portion must include graduate courses that demonstrates the knowledge, skills, and abilities necessary to do the work of the position. Note: Transcripts 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 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 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. This job opportunity announcement may be used to fill additional vacancies. The 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 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/.
