This position is located in Integrated Veterans Care (IVC), VA Community Care Operations (CCO). The primary mission is to efficiently administer health benefits for Veterans and family members. This is accomplished with an engaged workforce that focuses on results and leverages best practices. The Appeals Section or the Claims Adjudication and Reimbursement (CAR) Directorate provides appeal determinations based on policy and regulations that pertain to all CCO administered programs.

Duties

Duties include, but not be limited to: Provides technical advice both verbally and in writing to CCO staff on a broad range of appealable issues to include: beneficiary eligibility, benefit coverage, mental health, medical determinations, pre-authorization, denial payment issues, reimbursement, and timely filing. Conducts thorough research, problem-solving analysis, and interpretation and evaluation of laws, regulations, and policies associated with CCO-administered programs with the assistance of the Appeal Lead or Supervisor. Consults with Appeal Lead, Supervisor, nursing staff, and Policy Management Department staff (Benefits and Payments) regarding clinical appropriateness as well as on regulatory issues and policy interpretations. Maintains a data base of appeal decisions. This includes inputting appropriate and sufficient information into the data base to allow appropriate analysis and procedural modifications, when applicable. Identifies and recommends, with supporting documentation, necessary changes and process improvements within the employee's area of responsibility. Work Schedule: Monday - Friday, 8:00am - 4:30pm Compressed/Flexible Schedule: Flexible Position Description Title/PD#: Legal Admin Specialist/PD03233A and PD32390 Relocation/Recruitment/PCS Incentives: Not authorized

Requirements

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 10/11/2023. Time-In-Grade Requirements: You qualify for the GS-09 grade level if you possess one year of specialized experience equivalent to the GS-07 grade level and you meet the required time-in- grade of 52 weeks at a GS-07. You qualify for the GS-07 grade level if you possess one year of specialized experience equivalent to the GS-05 grade level and you meet the required time-in- grade of 52 weeks at a GS-05. EXPERIENCE: A specific length of training and experience is not required, but you must show evidence of training or experience of sufficient scope and quality of your ability to do the work of this position. Evidence which demonstrates you possess the knowledge, skills, and ability to perform the duties of this position must be supported by detailed descriptions of such on your resume. Applicants will be rated in accordance with the OPM Federal Wage System Qualification Standards. 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/Working Conditions: The work is primarily sedentary, although some walking, stooping, bending, reaching and carrying of loads up to 20 pounds is required . Use of a computer is extensive.

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.

Contacts

• Address Workforce Management - Community Care 120 SE 6th Street Suite 102 Topeka, KS 66603 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]