This position is located within the Department of Veteran Affairs (VA) Chief, Business Office, Non-VA Office of Community Care (NVCC) at the New Jersey Healthcare System in East Orange, NJ. This position authorizes and processes authorizations for payments of health care services delivered to Veterans and Family members by non-VA Providers and to provide support for the NVCC Program.

Duties

***THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION*** The major duties and responsibilities include but are not limited to: Processes authorizations falling under the Non-VA Office of Community Care (NVCC) Program; Ensures a new NVCC authorization is requested when a request for additional service is unrelated to care or treatment initially authorized, different diagnosis code, different procedure, or authorization is expired; Communicates to the VA patient per the required NNPO Non-VA Care Patient Appointment Letter (sent to the patient with a copy of the authorization) and the non-VA Provider Authorization Letter (sent to the non-VA provider with a copy of the authorization) to fill non-VA Prosthetic or Pharmacy prescriptions; Creates two reports from FBCS - Authorization Cost Estimation Report and Paid Claims Cost Estimation Report for each NVCC authorization; Checks for accuracy, adequacy of documentation authorizations, compliance with regulations and justification for medical care; Creates authorization analyzes to determine propriety of payments to include required, certifications by authorized officials, compliance with contract provisions, price agreements, and other directive material; Resolves discrepancies associated with the authorization, verifies cost data, and availability of funds; Creates and researches accounting records, reviews documents authorizing medical care of benefits, and determines the proper amount due for services authorized; Determines the adequacy of the authorization and the amount to be paid; Traces authorizations entered, prepares worksheets to reflect the source of discrepancies and the corrective action required to bring billing discrepancies into agreement; Inputs authorizations into Fee Basis Claim System (FBCS) and obligates the funds ensuring all costs are accurate and complete; Creates authorization letters to the Community Providers authorizing care for Veterans; and Performs other related duties as assigned. Work Schedule: Monday-Friday; 8:00am-4:30pm Recruitment & Relocation Incentives: Not authorized Critical Skills Incentive (CSI): 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

To qualify for this position at the GS-6 grade level, you must meet the following requirement: Specialized Experience: You must have one full year of specialized experience equivalent to the next lower grade level (GS-5) in Federal service that has equipped you with the particular knowledge, skills, and abilities to perform successfully the duties of the position, and that is typically in or related to the work of the position to be filled. Specialized experience is authorizing and processing payments for healthcare services, determining the proper appropriation to be charged for services, and resolving difficult reconciliations requiring corrective entries. 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. You will be rated on the following Competencies as part of the assessment questionnaire for this position: AuditingClericalCustomer Service (Clerical/Technical)Data ManagementDecision Making 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: Long periods of sitting in one location are required in completing transactions, using a computer with dual monitors as well as other standard office equipment. Work is performed in an office setting, but one that is considerably noisier and stressful than a typical office. 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

There is no educational substitution at this 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 New Jersey Health Care System 385 Tremont Avenue East Orange, NJ 07018 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]