Jesse Brown VA Medical Center Geriatrics and Extended Care (GEC) Service program areas. The incumbent processes payments for the Community Adult Day Healthcare Program and the Community Nursing Home Program. The primary functions of this position are to authorize, and process claims and invoices for payment of services delivered to Veterans by non-VA providers and to provide support for these programs.

Duties

Examines invoices and claims for services provided to Veterans enrolled in the Community Adult Day Healthcare Program and the Community Nursing Home. Determines the proper appropriation to be charged and that expenditures made are incurred only as specifically authorized. Examines a full range of claims having a variety of complicating factors to include a multitude of per diem rates established for each individual vendor, payment authorization and batching payment requests. Resolves discrepancies and/or problems that are associated with the claim certification process and enters/submits those certified claims into a centralized automated system. Prepares correspondence to all parties involved, including documentation transmitting adverse decisions or requests for additional information. Reviews all claims to ensure necessary processing information is present or suspends/rejects claims to appropriate queue and makes individual determinations on each claim based on legal entitlement specific to circumstances involved to include if the legal entitlement is specific to Veterans enrolled in the Community Adult Day Healthcare and Community Nursing Home Programs. Examines accounts and/or resolves difficult reconciliations requiring an analysis of adjustments and corrective entries in the account. Complies and verifies the accuracy of accounting data to prepare statements, reports, and schedules. Performs ancillary preparatory components of Adult Day Healthcare and Contract Nursing Home resolution responsibilities, such as documenting and monitoring episodes of care authorized, as well as maintaining ongoing contact with vendors to assure dates of services on claims are accurate for proper payment. Work Schedule: Monday- Friday 8:00 am to 4:30pm Telework: Available (Ad-hoc) Compressed/Flexible: Not Available Virtual: This is not a virtual position. Financial Disclosure Report: Not required

Requirements

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 03/25/2024. 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 6 position you must have served 52 weeks at the GS 5. 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 as described below: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS 5 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-Operating computer application software environment such as Medical Fee Claims Systems, Vista CNH Software, and Computerized Patient Record System. 2-Knowledge of documents required for program benefits determination and proper eligibility and enrollment. 3- Knowledge of the Community Care network authorization and payment process to include payment methodology.4-Knowledge of current editions of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9/10-CM) coding system, current Procedural Terminology (CPT-4) coding system, and Health Care Financing Administration Common Procedural Coding System (HCPCS).5-knowledge of the various automated accounting systems, methods, procedures, and techniques to research a variety of complicated transactions in order to analyze, determine and resolve issues surrounding payment and denials of claims. You will be rated on the following Competencies for this position: Computer SkillsDecision MakingInterpersonal SkillsReasoningWritten Communication Interpersonal Skills Decision Making Computer Skills Written 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: Long periods of sitting in one location are required in completing transactions, using a computer with dual monitors as well as other standard office equipment. 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

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 Jesse Brown Department of Veterans Affairs Medical Center 820 South Damen Avenue Chicago, IL 60612 US
• Name: Gemil Lewis
• Phone: 910-488-2120
• Email: [email protected]