The primary function of the incumbent is to assist the Chief, Patient Administration Service (PAS) by working closely with all clinical services and the Fiscal Service in the development and monitoring of patient consult and record processing and authorizations for medical care. This position serves as the point of contact for consult authorization processing for various medical services being performed at the affiliated medical school, DOD agencies, and by community providers.

Duties

Administrative management of the Consult Authorization Program, including validation and maintenance of FCPs and funding documents. Control and monitoring of consult programs to ensure approval by Service Chief and Chief of Staff. Entering authorizations in the Health Share Referral Management (HSRM) system and faxing authorizations to vendors. Keeping abreast of changes in Community Care Network Contract (CCN4), Public Laws, VA Regulations, Directives, and guidelines related to Community Care authorizations. Advising veterans and professional staff on eligibility determinations for authorized contracted services. Utilizing healthcare software systems like Computerized Patient Records System (CPRS), Advanced Medical Cost Management Solution (AMCMS), and Medicare Fee Schedule. Identifying diagnosis and procedure codes necessitating medical review for entitlement assessment. Coordinating appointments and patient processing using approved clinic access principles. Playing an integral role in problem resolution with administrative and clinical staff related to access and patient flow. Impacting processes, action plans, monitoring, and reporting. Determining veteran eligibility for care and processing complex health and administrative information. Coordinating Community Care services for Veterans throughout the STVHCS service area. Screening fee-for-service requests to determine eligibility status, completeness, accuracy, and urgency. Serving as the primary administrative contact and process expert for the STVHCS community care program. Maintaining relationships with PAS staff, CCN4 contracting staff, TriWest staff, patient advocates, and government offices to facilitate customer service activities and problem resolution. Work Schedule: Monday - Friday, 7:30am - 4:00pm or 8:00am - 4:30pm 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. Virtual: This is not a virtual position. Position Description/PD#: Program Specialist (Patient Administration Service)/PD02927A Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required

Requirements

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 12/11/2023. Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-9 position you must have served 52 weeks at the GS-7. The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment. You may qualify based on your experience and/or education as described below: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-7 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: medical knowledge, administrative acumen, and interpersonal skills to navigate healthcare administration complexities and ensure veterans receive care within the Community Care program; medical administration and understanding of healthcare systems, terminology, and patient care processes; experience with healthcare regulations, including Public Laws, VA Regulations, and Directives related to Community Care authorizations; healthcare software systems like CPRS, AMCMS, and Com Care CRM; communication including complex interactions with patients, healthcare providers, and stakeholders, involving intricate administrative and clinical tasks; processing health and administrative information accurately; coordinating and networking, building relationships with various stakeholders to facilitate patient care; experience as an educator and trainer, delivering information and education to internal and external parties. OR, Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have a master's or equivalent graduate degree, or, 2 full years of progressively higher level graduate education leading to such a degree, or, LL.B. or J.D., if related (TRANSCRIPT REQUIRED). OR, Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education beyond 1 full year of graduate level education. You will be rated on the following Competencies for this position: Customer Service Writing Analytical Reasoning Manages and Organizes Information Communication 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: Work is mostly sedentary with some walking, bending and standing in completing various stages of the daily task. The incumbent is required to answer numerous personal, electronic, and telephonic inquiries and must have adequate eyesight and hand dexterity to allow reading and operating a computer. 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

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.

Note: If your school has changed names, or is no longer in existence, you must provide this information in your application.

Contacts

• Address Audie L Murphy Memorial Veterans Hospital 7400 Merton Minter Boulevard San Antonio, TX 78229 US
• Name: VISN 17 SSU USAS Group
• Email: [email protected]