The incumbent serves as a Program Support Assistant 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.

Duties

Performs a wide variety of transactions, in support of medical care collections and revenue recovery. Responsible for the verification of Third Party Payer (TPP) precertification requirements of Veterans' insurance coverage for inpatient, outpatient, prescription, Care in the Community (CIC) authorized medical care, and prosthetics services. Reviews, analyzes, researches, and verifies insurance benefits, policy numbers, contact numbers for TPP care. Responsible for entering documentation of precertification activities according to established requirements in Claims Tracking. Retrieves clinical documentation and data from Veteran's electronic and paper health record that requires additional independent investigation, and judgement. Work Schedule: Mon - Fri, 40 hrs./wk. Tour of Duty set based on organizational need Position Description Title/PD#: Program Support Assistant/PD05206A Physical Requirements: The work is mainly sedentary performed in an office environment.

Requirements

• You must be a U.S. citizen to apply for this job
• Subject to a background/suitability investigation
• May serve a probationary period
• Selective Service Registration is required for males born after 12/31/1959
• A complete application package; Resume, Transcripts, etc.
• Selected applicants will be required to complete an online onboarding process

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement. GS-06 grade level: One year of specialized experience (equivalent to the GS-05 grade level in the federal service); experience that equipped the applicant with the particular knowledge, skills and abilities (KSA's) and other characteristics to perform successfully the duties of the position, and that is typically in or related to the work of the position to be filled, in the normal line of progression for the occupation in the organization. Specialized experience includes: 1) Interprets payer review criteria to comply with various health plans and benefit languages 2) Verifies Third-Party Payer requirements for insurance coverage 3) Uses various electronic processing programs, applications and computer systems to identify and resolve issues 4) Uses medical terminology while performing reviews of patient medical records for the Third- Party pre-certification process i.e. ICD-10/CPT/HCPCS codes 5) Performs healthcare support functions, operations and financial reporting There is no educational substitution for the GS-06 level. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.

Education

This job does not have an education qualification requirement.

Contacts

• Address CPAC Mid South 1412 Hazelwood Dr Smyrna, TN 37167 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]