The incumbent serves as a Medical Reimbursement Technician within the Consolidated Patient Accounts Center/CPAC - Revenue Operations; Billing and Insurance Verification Departments, Office of Community Care performing a broad range of duties to achieve the established Central Office expected results for medical billing and reimbursable and non-reimbursable collections. The incumbent may also perform insurance verification duties. Duty Location: Middleton, WI.

Duties

***THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION*** This position involves a multi-grade career ladder. The major duties listed below represent the full performance level of GS-6. At the GS-5 grade level, you will perform assignments of a more limited scope and with less independence. You will progressively acquire the background necessary to perform at the full performance level of GS-6. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher level work, and availability of funds. Duties include, but are not limited to the following:Duties will include, but may not be limited to the following: Use a wide range of office software applications such as Microsoft Access, Excel, and Word. Follow instructions about timeliness, objectives, and relative priorities for doing work. Take Responsibility for Medicare reimbursable billing activities. Interprets third party insurance policies and requirements for billing. Submit claims to 3rd party health Insurance Carriers, with knowledge of Medicare coverage benefits. Performs verification of patients' insurance coverage for inpatient/outpatient services; enters information and maintains databases. Performs reimbursement billing activities, including consideration of professional and facility services, sharing agreements, Tricare, Champ VA, Medical, and Pharmacy billing. Validates claims for billing purposes ensuring eligibility and refers questionable coding for review; monitors reports to assure all possible billable cases are processed, ensuring proper sequencing of diagnostic and procedural codes; tracks, reviews, and corrects denials. Work Schedule: Full Time, Monday-Friday, 8:00 am - 4:30 pm Recruitment & Relocation Incentives: Authorized - $1,500 Recruitment Incentive available for highly qualified applicants with a 12-month service agreement. Telework: VA supports the use of telework as a way to help attract and retain talented individuals in public service, increase worker productivity, and better prepare the agency to operate during emergencies. This position may be authorized for telework. Telework eligibility will be discussed during the interview process. Financial Disclosure Report: Not Required

Requirements

Qualifications

GS-5 EXPERIENCE: Possess at least one (1) full year of specialized experience equivalent to at least the next lower grade level (GS-4) in the Federal Service that has given you the knowledge, skills and abilities required to successfully perform the duties of a Medical Reimbursement Technician. Specialized experience includes follows instructions about timeliness, objectives, and relative priorities for doing administrative work; communicates with other staff as necessary to discuss administrative concerns; and reviews and determine the appropriateness of administrative data. OR EDUCATION: Possess successfully completed four (4) years of education above the high school level in any field which high school graduation or the equivalent is the normal prerequisite. This education 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. NOTE: If you select this option, you must submit a copy of your transcript with your application. Education cannot be credited without documentation. OR COMBINATION OF EDUCATION AND EXPERIENCE: Possess the equivalent combinations of successfully completed post-high school education (beyond the second year) and specialized experience, as described above, which meet the total experience requirements for this grade level. This education must have been obtained in an accredited business, secretarial or technical school, junior college, college, or university. NOTE: If you select this option, you must submit a copy of your transcript with your application. Education cannot be credited without documentation. GS6: SPECIALIZED EXPERIENCE:- Applicants must possess at least one (1) year of specialized experience that equipped them with the particular knowledge, skills, and abilities to perform successfully the duties of this position, and that is typically in or related to the work of this position. To be creditable, this experience must have been equivalent to at least the GS-5 level in the Federal service. Specialized experience includes: working in a medical billing environment for healthcare reimbursement and accounts receivables; verifying patient insurance coverage and eligibility; collecting from third party insurance companies; coding actions utilizing International Classification of Diseases (ICD-9) and Current Procedural Terminology (CPT/4) diagnostic codes; and auditing accounts. You will be rated on the following Competencies as part of the assessment questionnaire for this position: Customer Service (Clerical/Technical)Decision MakingManages and Organizes InformationSelf-ManagementTechnical Competence IMPORTANT: A full year of work is considered to be 35-40 hours of work per week. All experience listed on your resume must include the month and year start/end dates. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. 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; religious; 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. Physical Requirements: Position is sedentary. There are no unusual physical demands. The work is performed in an office setting. 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

IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education.

There is no educational substitution at the GS 6 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: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

Contacts

• Address VA NCCPAC Madison 8001 Terrace Ave Middleton, WI 53562 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]