Summary This position is located in the North-Central Consolidated Patient Account Center at the Department of Veterans Affairs (VA), Veterans Health Administration (VHA), VA Medical Center, in multiple locations. The primary purpose of this position is to perform a variety of functions, including enhancing revenue, using an industry best model built on regional management of key aspects of the revenue cycle, process standardization, accountability, and economies of scale. Responsibilities THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION Major duties and responsibilities will include: Cooperates with personnel within other organizational units in the wider employing organization to solve revenue problems applicable to Veteran accounts. Validating claims for billing purposes ensuring eligibility and referring questionable coding for review. Interpreting third party insurance policies and requirements for billing. Submitting claims to third party health insurance carriers, with knowledge of Medicare coverage benefits. Taking responsibility for Medicare reimbursable billing activities. Obtains data and other information from VA-specific change notifications and ad-hoc reports to proactively or retroactively correct 1st and 3rd party billing. Reviews for accuracy, adequacy of the documentation, compliance with regulations, and the justification of the action Following instructions about timeliness, objectives, and relative priorities for doing work. Exhibiting flexibility in adapting to changing demands within specific timelines. Receives workload from multiple worklist systems, electronic and mail notifications, VA specific internal and external data applications, emails, letters, and face-to-face customer service interactions. Accepting and completing work provided by a standardized control system such as batched work, caseload level, or other defined structure. Handling conflicting goals, objectives, priorities, timelines, and deadlines. Using a wide range of office software applications such as Microsoft Access, Excel, and Word. Composing correspondence on a situational basis. Analyzes each voucher or invoice to determine propriety of payment to include required certifications by authorized officials, compliance with contract provisions, price agreements, and/or other directives. Conducts analysis to develop required data and information reporting purposes and drafts brief factual administrative reports. Performs daily reviews, audits, and/or corrective actions in response to workload activities or requests received directly from Veteran customers, Office of General Counsel, internal and/or external compliance and quality measurement and performance teams, and the VA Office of the Inspector General (OIG). Provides accurate and proficient guidance to all customer groups regarding debt relief options such as formal repayment plans and waivers and interpreting insurance policy coverages, VA eligibility benefits, and other factors that impact Veteran financial accounts for both 1st and 3rd Party billing. Performs other duties as assigned Work Schedule: Monday - Friday; Full - Time, 8:00am - 4:30pm Recruitment Incentive: May be authorized for highly qualified candidates Critical Skills Incentive (CSI): Not approved Telework: This position may be authorized for telework. 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 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, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest. Qualifications To apply for this position, you must have the following qualifications: To qualify for this position at the GS-6 level, you must meet the following: SPECIALIZED EXPERIENCE: At least one (1) full year of specialized experience, equivalent to at least the GS-5 grade level, that equipped you with the particular knowledge, skills, and abilities (KSA's) to successfully perform the duties of the position, and that is typically in or related to the work of the position to be filled. Specialized experience is: providing customer service; educating patients; reviews, analyzes, process and completes co-payments and insurance for billing; reviews and processes specialty billing; reviews, analyzes, researches, and verifies insurance policy coverage and filing deadlines. NOTE: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week. A full year of work is considered to be 35-40 hours of work per week. 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. 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 Requrirements:The work is performed mainly in a sedentary manner. Occasional walking, standing, reaching, and bending are required. The carrying of light items such as paper, folders, and files between desk and storage is common. The work requires long period of interaction at computer terminals. 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/.
