The position is located within the VHA Office of Finance's Revenue Operations Consolidated Patient Account Center (CPAC) with the incumbent serving as the Payer Relations Specialist (PRS) for the CPAC. The CPAC is a regionally consolidated business entity established to enhance revenue operations throughout the VISN networks and across the VHA system through the standardization and consolidation of functions and processes, as well as the utilization of VHA and industry best practices.

Duties

Duties include but are not limited to: Conducts market research and rate verification analysis to determine market rates and payer compliance with federal laws. Monitors and tracks data associated with third party payer community care claim denials. Generates data to support identified trends in claim submissions and follow up activities. Identifies and develops recommendations for agreement modifications. Facilitates resolution of systemic issues related to contracted payer reimbursement and contracted third party payer agreement terms and conditions. Educates revenue operations staff on policies and procedures related to payer agreement issues. Develops communications, tools, templates, presentations and job aids to educate staff responsible for training. Work Schedule: Monday - Friday, 7:00am-4:00pm, Full-Time 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 Administrative Specialist/PD94958A Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized PCS Appraised Value Offer (AVO): 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, 02/20/2024. 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: 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: Conducts market research and rate verification analysis to determine market rates and payer compliance with federal laws Monitors and tracks data associated with third party payer community care claim denials. Assists in preparing and presenting briefings to senior leadership on a wide range of revenue operations and reimbursement related topics impacting or impacted by third party payer agreements. Develops plan of action with payers to bring payment practices into compliance with federal laws. Monitors TPP reimbursement and verifies that reimbursements are consistent and in accordance with public laws, Departmental and USG rules, directives and regulations, and specific insurance policy provisions. Investigates systemic issues and develops root cause solutions related to reimbursement issues. Resolves denial trends and claims processing errors. OR, Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have 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, Combination: Applicants may also combine education and experience to qualify at this level. You must have combinations of successfully completed graduate education and specialized experience directly related to the work of the Financial Administrative Specialist GS-11, position, which may be used to meet the experience requirements for GS-11 position. You will be rated on the following Competencies for this position: Accounting OperationsCustomer ServiceInsuranceProblem SolvingTechnical Competence 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 occasional travel and physical effort maybe 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: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

Contacts

• Address VA MACPAC Asheville 730 128 Bingham Rd. Suite #500 Asheville, NC 28806 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]