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. The incumbent reports to the CPAC RUR Nurse Manager.

Duties

RUR PSAs support the activities of clinical staff specific to the reimbursement cycle including precertification, continued stay, and clinical appeals/denials management. 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. Responsible to decide whether to initiate pre-notification, notification, precertification or to pend medical care authorization requests as appropriate based on their individual review and judgement of each unique case. Responsible for entering documentation of precertification activities according to established requirements in Claims Tracking. Transcribe the determination into Claims Tracking (CT) for permanent record and select the applicable Reason Not Billable (RNB). Work Schedule: Mon - Friday 8:00am - 4:30pm Position Description Title/PD#: Program Support Assistant/PD05206A Physical Requirements: The work is primarily sedentary but may require some physical effort such as periods of standing, walking, sitting, or bending. This position requires visual acuity, clear distinctive speech, and manual dexterity. This position requires potentially long periods of continued sitting and computer use and typing. The incumbent must be an individual capable of working effectively in stressful situations and able to shift priorities based on organizational needs.

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) Works independently to complete objectives, priorities and deadlines. 2) Uses various electronic processing programs, applications and computer systems to identify and resolve issues. 3) Researches customer service complaints and uses sound judgment in preparing information for review. 4) Performs administrative activities, which include a variety of problems, questions, or situations that have a significant impact on revenue reimbursement. 5) Verifies Third Party Payer (TPP) precertification requirements of insurance coverage. 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 VA FCCPAC Orlando 733 13800 Veterans Way Orlando, FL 32814 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]