Summary The Program Support Assistant serves within the Revenue Operations (RO) Consolidated Patient Accounts Center (CPAC) Revenue Utilization Review (RUR) department. The CPAC is a regionally consolidated business line established to enhance revenue within the Veterans Health Administration (VHA) using an industry-best model built on regional management of key aspects of the revenue cycle, process standardization, accountability, and economies of scale. Reports to the CPAC RUR Nurse Manager. Responsibilities Some of the major duties include but not limited to: Performs a broad range of duties to assist in achieving the RO/CPAC expected results for first and third party collections - Make decisions/recommendations based on the development and evaluation from various sources. - Make independent decisions in a wide variety of unique clinical scenarios. - Interpret payer review criteria to comply with various health plans and benefit languages. - Adapt to continuing changes in program, technological developments and conflicting requirements. - Use medical terminology to perform reviews of patient medical records for third party pre-certification process. - Verify third party payer requirements for Veterans' insurance coverage. - Respond appropriately to questions and inquiries from third party payers and internal customers. - Exhibit flexibility and consideration when working with internal and external stakeholders. - Reviews data analytics and metric expectations. - Prioritize workload according to department need and leadership direction. Work Schedule: Mon-Fri 08:00am-4:30pm Compressed/Flexible: Available at managements discretion Telework: This position may be authorized for telework. Telework eligibility will be discussed during the interview process. Position Description/PD#: Program Support Assistant (RUR)/PD05206A 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) - 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 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, 08/11/2026. 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. Examples of specialized experience would typically include, but are not limited to: Support the activities of clinical staff specific to the reimbursement cycle including precertification, continued stay, and clinical appeals/denials management. Review criteria to comply with various health plans and benefit languages Retrieves clinical documentation and data from Veteran's electronic and paper health record that requires additional independent investigation, and judgement 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. 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. 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. 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/.
