The incumbent is responsible for the administrative aspects of eligibility and benefits determination activities for the CBOC and Medical Center including annual means tests eligibility updates. The position is aligned in the Health, Eligibility & Processing (HE&P) Section of Health Administration Service (HAS).

Duties

Incumbent coordinates final determination/verification of eligibility/entitlement to VA health care benefits for applicants received by the CBOC and Medical Center and also provides training to staff of Community Based Outpatient Clinics (CBOCs). Incumbent makes final determination as to whether veteran meets legal requirements for medical care by means of documentation, or if documentation is not available, initiates search for needed verification. Determines which medical care benefits the veteran is eligible for by means of a working knowledge of appropriate medical administration related laws, policies, guidelines, and regulations. Incumbent coordinates adjudicative action with VBA as appropriate. The Eligibility staff assists in advising ineligible applicants of their status and referring to other appropriate resources as needed. Incumbent refers applicants, whether eligible or ineligible to Primary Care staff when appropriate to ensure urgent or emergent health conditions are addressed. If applicant is ineligible for VA medical treatment, incumbent ensures Primary Care staff is aware of ineligible status and encourages referral to non-VA facilities once applicant's condition is determined stable. Incumbent receives and processes applications for specialty treatment/care, including, but not limited to the Dental, Domiciliary, Homeless, SATP, PCT, and NHCU programs. Incumbent makes final eligibility determinations, establishes priority/category/authorization for care, refers for appointment, etc. Incumbent ensures all appropriate correspondence is completed for applicants, informing them of decisions and advising of appellant rights. Incumbent assist social work service supporting the functions of the Long Term Care Program ensuring timely and accurate entry of financial data determining patients copay status. Incumbent receives and processes annual update of patient information to include means test information. Incumbent is responsible for processing of Veterans Identification Cards ensuring all information is current and accurate. Incumbent must have the ability to comprehend and interpret multiple written and complex directives. Interpretation must be made in order to apply the proper regulation to the individual application in order to ensure the veteran receives full benefits due. Incumbent must have the ability to explain laws and regulations. Incumbent independently carries out a wide range of contacts both within and outside the CBOC and Medical Center, involving a range of problems and situations from typical to very difficult. Incumbent is responsible for preparing official correspondence. Performs other related duties as required. Work Schedule: Friday, 8:00 AM to 4:30 PM Virtual: This is not a virtual position. Position Description/PD#: Claims Assistant/PD01744A

Requirements

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 05/06/2024. 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 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 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-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: Interviewing applicants by phone or in person to determine whether they are eligible for enrollment for healthcare; Interpreting and applying knowledge of healthcare options, local, state, and national policies to be able to accurately respond to inquiries about eligibility for health care and benefits; Reviewing military service documents, and other documents to make eligibility determinations for healthcare; Assisting applicants and stakeholders with completing applications for enrollment for healthcare benefits, including, but not limited to, regular enrollments, hardship enrollments, catastrophically disabled enrollments, and applications for death benefits. You will be rated on the following Competencies for this position: Administrative LawAttention to DetailCustomer ServiceEmployee DevelopmentSpeaking 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 sedentary with walking, standing, bending, and light lifting (such as supplies and patient records). 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

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: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

Contacts

• Address Carl Vinson VA Medical Center 1826 Veterans Boulevard Dublin, GA 31021 US
• Name: Tonia Warren
• Phone: 8287728981
• Email: [email protected]