These positions are assigned to the VA Office of Integrated Veteran Care (IVC), Integrated External Networks, Customer Experience, Customer Service at the VA Medical Center in Denver, CO. The primary function of the Contact Representative is advising, counseling, reviewing applications and claims and/or responding to requests regarding business processes for all associate health benefits programs which are administered by the IVC.

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-6/7 grade levels, 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. The major duties include but are not limited to: Develops, examines, adjusts, reconsiders, recommends settlement of various types of claims, receives and processes requests for authorization of healthcare services, supplies and benefits; Prepares and develops claims and gives advice and assistance in obtaining evidence and supporting documents that are required to complete the transaction; Routinely researches and locates information that is missing or lacking in detail to ensure the packet is complete and adequate for processing; Furnishes information concerning rights and benefits with regard to assigned health benefit programs; Provides customers with advantages and disadvantages to various benefit options and discusses various alternatives; Assists in determining the status of claims for services; Redevelops claims for reprocessing, ensuring that all required information and documents are present and complete to facilitate payment of claims; Explains and advises the basis for payment decisions and reasons for disallowance; Explains payment methodologies used in adjudicating medical claims to resolve questions about allowable amounts and cost shares; Examines claims for errors and initiates action to correct such errors; Works directly with patients, beneficiaries, providers and collection agencies in an effort to mitigate or resolve situations in which the patient or beneficiary has been placed in an adverse credit situation due to non-payment and/or untimeliness of payment of medical claims; Advises, counsels and reviews applications for benefits for assigned health benefit programs administered by the IVC; Conducts telephone interviews and creates responses to inquiries regarding any program administered by the IVC; Records new and/or updated information in computerized database(s) necessary for maintaining, routing and tracking correspondence; Reviews and recommends approval or denial of preauthorization requests based on program guidelines, applicable laws and regulations; Composes responses to inquiries in those cases where replies are required; Conducts and/or assists in the testing of new programs, enhancements to existing processes and new initiatives impacting customer service; Assists with on-the-job training for newly appointed Customer Service Representatives; and Performs other related duties as assigned. Work Schedule: Monday through Friday, 8:00am to 4:30pm Recruitment & Relocation Incentives: Not authorized Critical Skills Incentive (CSI): Not Approved Financial Disclosure Report: Not Required 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.

Requirements

Qualifications

To qualify for this position at the GS-6 level, you must meet the following requirement: SPECIALIZED EXPERIENCE: You must have at least one (1) full year of specialized experience equivalent to at least the next lower grade level (GS-5) in the federal service that has given you the particular knowledge, skills and abilities required to successfully perform the duties of a Contact Representative, and that is typically in or related to the work of the position to be filled. Specialized experience is performing duties of a more limited scope and with less independence such as receiving and reviewing benefit applications and associated documents; entering data into a computerized database; researching guidelines and policies to make proper eligibility determinations; preparing correspondence; and communicating with beneficiaries, family members, and other interested parties. NOTE: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week. To qualify for this position at the GS-7 level, you must meet the following requirement: SPECIALIZED EXPERIENCE: You must have at least one (1) full year of specialized experience equivalent to at least the next lower grade level (GS-6) in the federal service that has given you the particular knowledge, skills and abilities required to successfully perform the duties of a Contact Representative, and that is typically in or related to the work of the position to be filled. Specialized experience is performing duties of a more limited scope and with less independence such as determining eligibility for medical benefits; receiving and reviewing benefit applications and associated documents; entering data into an eligibility database; researching guidelines and policies to make proper eligibility determinations; preparing correspondence; and communicating with beneficiaries, family members, and other interested parties. NOTE: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week. You will be rated on the following Competencies as part of the assessment questionnaire for this position: Analytical ReasoningCommunicationsCustomer ServiceOperating Systems 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 although some walking, stooping, bending, reaching and carrying loads weighing up to 20 pounds is required. Use of computer and telephone is extensive. Work is performed in a fast paced and sometimes stressful professional office environment. 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.

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]