This position is within Care in the Community (CITC) at the Lexington VA Health Care System and reports to the Assistant Administrative Service Chief. This position will require knowledge of the various resources available to Veterans. Performs reviews by examining Veteran's medical records, community care authorizations, community payment records, and historical tracking of submitted health care claims.

Duties

The Care in the Community (CITC) program's mission includes efficiently administering health care benefits for enrolled Veterans receiving medical care and services through the community care program. This is accomplished with an engaged workforce that focuses on results and leverages best practices. CITC provides oversight, guidance, and support to the VA in many different capacities: research, training, development, interpretation, and evaluation of existing health care policy and regulations that pertain to medical benefits, community care, emergency care, and authorized medical care. The primary purpose of this position is to improve the Veteran and community care provider experience with Care in the Community. Major Duties include, but are not limited to:

Requirements

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 09/26/2023. Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. 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. You may qualify based on education and/or experience as described below: 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 is experience where you were responsible for performing reviews by examining medical records, authorizations, community payment records, and historical tracking of submitted health care claims. Conduct performance reviews to determine the economy, efficiency, and effectiveness of program operations and to determine whether the entity has complied with laws and regulations applicable to the program. Provides consultative services to customers, staff, and other stakeholders to facilitate performance improvement by providing training with regards to business and financial processes as well as internal controls. Perform a variety of support service functions and related work in dispersing information to the public on rights, benefits, privileges, or obligations; explaining pertinent legal provision, regulation, and related administrate practices, and their application to specific cases; and assisting individuals in developing needed evidence and preparing required documents, or in resolving errors, delays, or other problems in obtain benefits or fulfilling obligations. Note: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hour worked per week. To be creditable, specialized experience must have been equivalent to at least the next lower grade level in the normal line of progression for the occupation in the organization. Unpaid experience is creditable, provided the work done was of a quality level and demonstrated the ability required for the position. This includes directly connected with the production aspects of the field(s) of the position to be filled; Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related. OR Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education beyond 1 full year of graduate level education or superior academic achievement. Preferred Experience: Experience working in medical billing and provider relations preferred. Experience in discovering, analyzing and resolving software and application issues. Experience in customer service management preferred. You will be rated on the following Competencies for this position: Customer Service Decisiveness Self-Management Manages & Organizes Information 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. Note: A full year of work is considered to be 35-40 hours of work per week. 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. Physical Requirements: The work is primarily sedentary; however, there is a certain amount of mobility (walking/standing) associated with this position to physically visit the site locations of users. 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: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

Contacts

• Address Lexington VA Health Care System 2250 Leestown Road Lexington, KY 40511 US
• Name: Yvette Cook
• Phone: 4053974128
• Email: [email protected]