Located with the Veterans Health Administrations Specialty Programs Department (SPD), Veteran and Family Member Programs (VFMP) Directorate, this position reviews, analyzes, and adjudicates claims for the Foreign Medical Program (FMP). These are claims for medical services performed outside of the United States for Veterans with VA rated service-connected conditions.

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-8. At the GS-7 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-8. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher level work, and availability of funds. Major duties and responsibilities include: Processing foreign medical claims on a complex manual system, without automation or artificial intelligence assistance Utilizing an extensive knowledge of diagnostics and medical services Performing complex diagnostic and procedure coding Independently applying and interpreting laws and regulations set forth in the program policy to adjudicate medical claims Examining, developing, and evaluating relevant documentation related to claims submitted for payment Independently performing research to determine whether conditions treated on medical claims are service-connected or associated with or aggravated by the Veteran's listed service-connected condition(s) Utilizing medical reference books, medical dictionaries, online medical websites, coding software, etc. in performing research related to complex medical claims Converting foreign currency to the equivalent amount in United States dollars Applying expert understanding of the laws and regulations governing the FMP and all technical aspects of processing FMP claims to perform research and responds to Congressional and White House inquiries. Performing other duties as assigned Work Schedule: Monday through Friday, between the hours of 6:00am and 4:30pm Recruitment & Relocation Incentives: Not authorized 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-7 level, you must have: At least one (1) full year of specialized experience that equipped you with the knowledge, skills, and abilities to successfully perform the duties this Claims Examiner - Healthcare Claims, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level (GS-6) in the Federal service. Specialized experience is experience in the health care industry which provides a basic knowledge of health insurance policy and plan types, and healthcare claims processing operations. At this level applicant experience should reflect performing fact finding procedures to fully assess a situation; gathering information through analysis of records; verifying information to ensure accuracy; and making determinations in adherence with laws, regulatory guidance, and agency policies. 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 qualify for this position at the GS-8 level, you must have: At least one (1) full year of specialized experience that equipped you with the knowledge, skills, and abilities to successfully perform the duties this Claims Examiner - Healthcare Claims, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level (GS-7) in the Federal service. Specialized experience is experience that required application of comprehensive knowledge and experience in the health care industry which provides an overall knowledge of healthcare claims processing operations, provider relations and reimbursement techniques, payment methodologies, coordination of benefits, and medical care cost recovery activities. At this level applicant should function independently in the processing of medical claims, and formulating interpretations of the intent, coverage and content of instructions, guides, precedents, and regulations - only seeking guidance in the most difficult problems. 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: Attention to DetailComputer SkillsCritical ThinkingMedical InformationReal Estate 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: The work is primarily sedentary with occasional requirements to walk around in an office building to meet with employees. Most work requirements involve using a computer and standard office automation equipment. The incumbent may need to stoop, bend, reach, or occasionally carry loads weighing up to 20 pounds. 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 education substitution at this grade level.

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]