The position is located within the Consolidated Patient Account Center (CPAC), organizationally aligned under the Office of the Director, Quality Assurance Department. The CPAC is a regionally consolidated business entity established to increase revenue with VHA using an industry best model built on regional management of key aspects of the revenue cycle, process standardization, accountability and economies of scale for several Veterans Integrated Service Networks.

Duties

Identifies systemic causes for major denial categories and develops plans and recommendations to effectively address the management of claim denials. Interprets billing and collection laws, rules, regulations, and polices, developing and implementing local polices, and procedures for the management of denied claims. Ensures that proposed changes to charges for healthcare services, medications and/or equipment are in conformance with the appropriate law, rules, regulations and other guidelines. Identifies and evaluates patterns and trends in payer denials. Provides guidance and assistance in monitoring activities designed to ensure the integrity and accuracy of charges for healthcare services, equipment and/or medications. Work Schedule: Monday to Friday. 8:30 am to 4:30 pm Compressed/Flexible: May be available, based on organizational need 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 Management Specialist/PD731980 Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): 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, 07/22/2024. 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 G-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: 1) Provides guidance and assistance to others in performing complex analysis and evaluation of healthcare claims data, and third party denials. 2) Performs analysis of data from hard copy Explanation of Benefits (EOB) or Electronic Explanation of Benefits (EEOB) to identify whether a claim was denied payment and/or adjustments made by the payer. 3) Reviews EEOB reports that provide the information for analysis; on denials, trends and adjustments. 4) Ensures that the re-submission of denials claims is conducted in accordance with established laws, rules, regulations and policies. 5) Develops recommendations for adjustments to billing procedures and/or processes in order to reduce payers denials of agency healthcare claims. OR, Education: Applicants may substitute education for the required experience (TRANSCRIPTS REQUIRED): Do you possess 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 (TRANSCRIPTS REQUIRED): Do you possess combinations of successfully completed graduate education and specialized experience directly related to the work of the Financial Management Specialist position, which may be used to meet the experience requirements for GS-11 position? Note: Evidence of specialized experience must be supported by detailed documentation of duties performed in positions held on your resume. You must provide work experience information such as hours per week, salary, and starting/ending dates of employment (month and year format) to establish you have one (1) full year of Specialized Experience at or comparable to the required grade level. Analytical ReasoningCommunicationInsuranceLeadership 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 some slight physical effort may be 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 CPAC Mid South 1412 Hazelwood Dr Smyrna, TN 37167 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]