The Reimbursement Technician position is in the Office of Chief Operating Officer (COO), Consolidated Patient Account Center (CPAC), VHA Office of Finance, Revenue Operations, Facility Revenue Division, Veterans Health Administration, Department of Veterans Affairs, Pittsburgh, PA. The Reimbursement Technician serves as a keystone agent acting between VAMC station personnel and multiple CPAC revenue teams to conduct, capture, and communicate assigned revenue cycle CPAC processes.

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-7. At the GS-6 grade level, the individual performs assignments of a more limited scope and with less independence. The individual will progressively acquire the background necessary to perform at the full performance level of GS-7. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher-level work, and availability of funds. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher-level work, and availability of funds. Duties can include, but are not limited to: Performs first (1st) and third (3rd) party facility revenue actions by identifying the type of action, verifying guidelines(s) requirements, and obtaining encounter-specific information using multiple automated data delivery systems. Revenue actions require identification of specific agency revenue program requirements (e.g., Federal laws, VA practices). Verifies the copayment status of actions and specific program requirements for care received to determine whether copayments for care outside the Agency and/or retroactive billing of copayments based on income-based exemption determinations are required. Receives workload from multiple worklist systems, electronic, and mail notification, VA specific internal and external data applications, emails, letter, and face-to-face customer service interactions. Accesses, reviews, operates, and processes various revenue specific systems, procedures, transactions, reports, and action to identify, verify completeness and accuracy, locate missing data and/or information. Reviews, researches, analyzes all accounts receivable records and documentation, to ensure all data maintained is accurate, current, and proper based on Agency regulations, policies, Federal Laws and Directives. Performs required follow-up action to ensure proper debt collections procedures are adhered to, follows-up phone calls and letters and proper due process rights in accordance with Federal Laws and Agency Policies. Corresponds with internal and external agency customers, beneficiaries, vendors, insurance companies, legal representatives, and General Counsel by mail, email, telephone, or facsimile, regarding receipts; indebtedness; proper application of collections, disputes, cancellation, administrative write-off, return mail and third-party liability cases. Takes appropriate action to satisfy inquiries, research materials, coordinates with involved parties in resolving questions and determination of circumstances. Reviews and analyzes case information, remittance statements from the third-party payer and others, and the accounts receivable record relating to the debt, the Debtor, for making a recovery determination which protects the interest of the Government. Reviews and analyzes account information, interviews, and obtains remittance statements, court orders, legal documents, insurance benefit coverage information to determine the best course of action. Uses judgment and experience to reconstruct incomplete files, devise more efficient methods for procedural processing, gather and organize information for inquiries and resolve a variety of problems. Details discrepancy and returns incomplete or discrepant information to requester for clarification. Works independently and is responsible for all collection functions. Maintains account receivable supporting documentation. Perform other related duties as assigned. Work Schedule: Monday - Friday; 8:00am to 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

ENGLISH LANGUAGE PROFICIENCY: In accordance with 38 U.S.C. 7402(d), No person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. You must be proficient in basic written and spoken English in order to meet the requirements of this position. AND Specialized Experience GS-6: One (1) year of specialized experience equipped with the knowledge, skills, and abilities to successfully perform the duties of the position. To be creditable for the GS-05 the experience must have been equivalent to the GS-04 in Federal service. Examples of experience includes working knowledge and ability to utilize electronic data processing systems and software applications for 3rd party billing, 3rd party denials management, release of information (ROI) responsibilities, routing customer request actions to responsible teams, completion of 1st party billing and charge creation or reconciliation adjustments verification of eligibility through financial document review and completion of workflow using agency specific electronic systems, databases, and programs; understanding of guidelines (e.g., legal, regulatory, procedural), practices and procedures and skill in applying; comprehension of and related skill in research and verbal and written communication to explain guidelines (e.g., laws, directives, handbooks); performs 1st and 3rd party billing, denials processing/correction, customer service, and resolve multifaceted problems complex in nature; versed in regulations, policy, public laws, and directives regarding wider organizational responsibility for revenue operation (i.e., Medical Care Cost Recovery (MCCR) program); and healthcare eligibility group/codes, income screening guidelines and limits, and of information (ROI) requirements for first( 1st) and third (3rd) party account reconciliation and remedy actions. You will be rated on the following Competencies as part of the assessment questionnaire for this position: Customer Service (Clerical/Technical)InsuranceOrganizational AwarenessTechnical Competence 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 performed mainly in a sedentary manner. Occasional walking, standing, reaching, and bending are required. The carrying of light item such as paper, folders, and files between desk and storage is common. The work requires long periods of interaction at computer terminals. 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

IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on 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: Recognition of Foreign Qualifications | International Affairs Office (ed.gov).

Contacts

• Address VA NECPAC Lebanon 734 1700 South Lincoln Avenue Lebanon, PA 17042 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]