This position is located in a Veteran Affairs Medical Center (VAMC) facility aligned with a Consolidated Patient Account Center (CPAC). The CPAC is a regionally consolidated business entity established to enhance revenue within Veterans Health Administration (VHA) using an industry best model built on regional management of key aspects of the revenue cycle, process standardization, accountability, and economies of scale.

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, you will perform assignments of a more limited scope and with less independence. You 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. Duties include but may not be limited to: Performs first (1st) and third (3rd) party facility revenue actions by identifying the type of action, verifying guideline(s) requirements, and obtaining encounter-specific information using multiple automate data delivery systems. 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. Cooperates with personnel within other organizational units in the wider employing organization (e.g., insurance verification, revenue utilization review, medical and prescription billing, Veteran services, denials management, outpatient pharmacy electronic claims, and/or accounts management) to solve revenue problems applicable to Veteran accounts. Reviews data presented from electronic or paper Explanation of Benefits (EOB)/Electronic remittance Advice (ERA) files when reviewing Veteran accounts to ensure 3rd party payments received by VA are accurately applied to Veteran accounts with 1st party copayment responsibility for the same dates of service. Documents account status updates, transactions, decisions, and other action for facility revenue billing and payment activities in the electronic health record system of record. Processes internal actions to overturn claim denials proactively or reactively from insurance carriers, care delivered outside the walls of VA through legacy/traditional systems, as well as newer programs mandated by Congress. Reviews outpatient encounters, inpatient admissions and discharges, long-term care visits, workers' compensation data/information, VA employee health visits, and specialty encounters to gain the requisite data necessary for 3rd party billing preparation. Reviews and researches veteran insurance policy coverage to prepare and process revenue billing and collection from 3rd party insurance providers. Prepares specialty-specific 3rd party billing transactions, which are more complex and require research, preparation, and problem solving beyond traditional 3rd party billing actions. Performs other related duties as assigned. Work Schedule: Fulltime, Monday-Friday, 8:00am - 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

To qualify at the GS-6 level you must meet the following: For the GS 6 position you must possess one (1) year of specialized experience equivalent to at least next lower grade level (GS 5). Specialized experience includes but is not limited to: Providing customer service to meets the needs of the customer; Providing patient education to a diverse customer base utilizing telephone, face to face, electronic or written correspondence; Identifying, reviewing, analyzing, processing and completing co-payments and insurance encounters and other billing related activities; Reviewing and processing all specialty billing encounters; Reviewing, analyzing, researching, and verifying insurance policy coverage, filing time frames, coordination of benefits (COB) information and certification requirements for secondary billing. Note: Resume must clearly support the duties and experience required for this position. We will not make assumptions regarding experience. To qualify at the GS-7 level you must meet the following: For the GS 7 position you must possess one (1) year of specialized experience equivalent to at least next lower grade level (GS 6). Specialized experience includes but is not limited to: Providing customer service to meets the needs of the customer; Providing patient education to a diverse customer base utilizing telephone, face to face, electronic or written correspondence; Initiating, gathering, and processing third (3rd) party revenue actions related to legal case activities by applying appropriate and relevant guidelines; Researching and recognizing data for billing to 3rd party insurance companies using a specified patient claims information system database; Determining the best course of action for both external and internal customer co-payments, insurance and pharmacy billing and other benefit-related activities involving the use of many different methods and resources.; Providing sufficient information to determine the required or most appropriate actions to take or opt in to benefits or privileges, afforded to patients under Federal law and/or Regulations. Note: Resume must clearly support the duties and experience required for this position. We will not make assumptions regarding experience. 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 primarily is sedentary, although some slight physical effort may be required. Some work may require walking, carrying light supplies/work records, utilizing telephone, fax, computer, copier and other standard office equipment. Occasional travel for training or attendance at national meetings is also 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

There is no educational substitution at the GS-6 and GS-7 grade levels.

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 WCPAC Las Vegas 736 1085 Palm Airport DR Las Vegas, NV 89119 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]