This position is located in a consolidated patient account center(CPAC) in the organization of the Office of the Director with the incumbent serving as the Financial Management Specialist (Denials) reporting to the Quality Assurance Manager. The CPAC is a regionally consolidated business entity established to increase revenue operations throughout the VHA network.

Duties

Manages information and analytical systems in order to evaluate and enhance the quality of service provided to patients. Develops and implements information systems to help analyze payments receive against Billings to ensure payments are consistent and in accordance with specific insurance policy provisions and identifies patterns and trends in denial of healthcare claims. Provides guidance and recommendations and assistance to others in performing complex analysis and evaluation of healthcare claims data and third party denials. Identify as an invalid waste patterns and trends impaired denials, develops recommendations for adjustments to billing procedures and or process in order to reduce payer denials of agency healthcare claims conducts meetings briefing trainings and other oral presentations on a wide variety of issues and subjects affecting the submission of health care claims and denial of claims by pairs. Interpret billing and collection laws rules regulations and policy developing and implementing local policies and procedures for the management of denial claims. Monitoring and evaluating administrative activities implementing substantive recommendations for program improvements ensuring effective use of office staff and resources and recommending needed changes to enhance services and revenue collections Work Schedule: 40 hours per week; Monday-Friday; 7:30 am - 4:00 pm Compressed/Flexible: May be available, pending supervisor discretion 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#: Financial Management Spec/PD019130 Relocation/Recruitment Incentives: Not Authorized 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, 12/22/2023. 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-11 position you must have served 52 weeks at the GS-09. 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: GS-11 Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-09 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: 1) Provides guidance and assistance to others in performing complex analysis and evaluation of healthcare claims data, and third party denials. 2) Performs analysis of data from hard copy Explanation of Benefits (EOB) or Electronic Explanation of Benefits (EEOB) to identify whether a claim was denied payment and/or adjustments made by the payer. 3) Reviews EEOB reports that provide the information for analysis; on denials, trends and adjustments. 4) Ensures that the re-submission of denials claims is conducted in accordance with established laws, rules, regulations and policies. 5) Develops recommendations for adjustments to billing procedures and/or processes in order to reduce payers denials of agency healthcare claims. OR; Substitution of Education for Experience (TRANSCRIPTS REQUIRED): Do you possess a PhD. or 3 full years of progressively higher level graduate education leading to such a degree or LL.M., if related. Such education must demonstrate the knowledge, skills, and abilities necessary to do the work. OR; GS-11: Combination of Education and Experience (TRANSCRIPTS REQUIRED): Do you possess combinations of successfully completed graduate education and specialized experience directly related to the work of the Financial Management Specialist, GS-11, position, which may be used to meet the experience requirements for GS-11 position? Note: Evidence of specialized experience must be supported by detailed documentation of duties performed in positions held on your resume. You must provide work experience information such as hours per week, salary, and starting/ending dates of employment (month and year format) to establish you have one full year of Specialized Experience at or comparable to the required grade level. You will be rated on the following Competencies for this position: Analytical ReasoningCommunicationInsuranceLeadership 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: The work is primarily sedentary, although some slight physical effort may be required. 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.

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]