The position is located in the Health Administrative Services, Patient Services Section, at VA Central Western Massachusetts Health Care System, in Leeds MA. The incumbent examines and processes claims/applications for Veterans services, benefits and programs.

Duties

The work includes varied duties requiring many different and unrelated entitlement processes and different methods that are applied to a broad range of VA and non-VA care activities. The incumbent is able to independently manage position responsibilities with little supervision and set priorities and deadlines adjusting the flow and sequencing of the work to meet team and customer needs. Makes determinations on entitlements based on current regulations, laws and policies; evaluates qualifying documentation, ensures compliance with regulation and authority when making entitlement process decisions for new and renewing Veterans. Other duties include: Examines a variety of routine and complex claims/applications for entitlement and/or payment, to include adjudication of authorized and unauthorized services, programs, travel for Veteran and Family Member programs for within a worldwide VA claims benefits program. Examines vouchers, invoices, claims, and other requests for entitlements for programs and services provided to or by the Government or for reimbursement of expenditures for travel and transportation, for accuracy, adequacy of documentation, or citations, compliance with regulations, and justification for Veteran and Family Member programs in a worldwide VA claims benefits program. Examines a full range of vouchers having a wide variety of complicating factors to include contradictory entitlement criteria found in certain special authorities, congressional actions, special considerations, VBA and HEC adjudications, fiscal exemptions, and non-routine payment authorizations. Researches and gathers information, identifying and analyzing issues, and preparing documents. Addresses problems and issues of varying complexity; situations vary significantly with each assignment. Corrects registration inconsistencies, enters external data and responds to entitlement queries by utilizing various established tracking methods (e-mail responses and spread sheet). Ensures claims, vouchers and other financial documentation is accurately and correctly completed for inpatients. Determines adequacy of information in support of a claim. Reviews all claims/applications to ensure necessary processing information is present or suspends/rejects claims/applications to appropriate queue. Authorized payments and determines the adequacy of invoices and the amount to be paid. Enters payment information into a computerized claims payment processing system which is applicable to the claim type, and program type unless internal or external correspondence is required. Reviews claims/applications for payment or reimbursement for entitled services. Determines whether a claim meets certain basic criteria. Certifies vouchers for payment and enters/submits those certified vouchers into a centralized automated system. Prepares correspondence to all parties involved, including letters transmitting adverse decisions or requests for additional information Promotion Potential: The selectee may be promoted to the full performance level (GS-06) without further competition when all regulatory, qualification, and performance requirements are met. Selection at a lower grade level does not guarantee promotion to the full performance level. Work Schedule: Monday - Friday 7:30 am - 4:00 pm, 40 hours a week, EST. 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#: Voucher Examiner/PD029130,02912 Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized Note: This position is a Bargaining Unit position. This position is in the Competitive Service. This position is covered by locality-based comparability pay. Interchange Agreements with Other Merit System: Employees who occupy medical or medical-related positions and were appointed under 38 U.S.C. 4701(1) or (3) [formerly 38 U.S.C. 4104 (1) and (3)] must be serving in a full-time position without time limit and have served continuously for at least one year in this other merit system to be eligible to convert to the Title 5 System. Some exceptions to this rule may apply if you have previously acquired tenure under a Title 5 appointment. Current employees must submit copies of their most recent SF-50, (Notice of Personnel Action). The SF-50 must identify the position title, series, grade, step, tenure and type of service (Competitive or Excepted). In some cases, more than one SF-50 may be required to show a higher grade previously held.

Requirements

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 11/06/2024. 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 a GS-05 position you may be advanced without time restriction to positions up to GS-05 if the position to be filled is no more than two grades above the lowest grade the employee held within the preceding 52 weeks under his or her latest nontemporary competitive appointment. For a GS-06 position you must have served 52 weeks at the GS-05. 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 must qualify for the GS-05 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-04 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: examining and processing claims for services, benefits, and programs; examine a variety of routine and complex claims/applications for entitlements and/or payment (i.e., travel for Veterans and family members); determine adequacy of information in support of a claim; conduct research, problem-solving analysis, and interpretation and evaluation of laws, regulations, and policies applicable to claims processing. (Must be reflected on your resume.). OR, Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have 4 years above high school. Degree must be relevant to the position to be filled. (Transcripts must be provided). OR, Combination: Applicants may also combine education and experience to qualify at this level. You must have a combination of specialized experience and education beyond the first 60 semester hours (i.e., beyond the second year) is creditable toward meeting the specialized experience requirement. One full academic year of study (30 semester hours) beyond the second year is equivalent to 6 months of specialized experience. The education and experience must be directly related to the work of the position to be filled. You must qualify for the GS-06 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-05 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Examining and processing claims for services, benefits, and programs; Examines a variety of routine and complex claims/applications for entitlements and/or payment (i.e., travel for Veterans and family members); Determining adequacy of information in support of a claim; researching, gathering information, Identifying and analyzing issues, and preparing documents; providing technical advice both verbally and in writing to staff. (Must be reflected on your resume.). You will be rated on the following Competencies for this position: Attention to DetailComputer SkillsCustomer Service (Clerical/Technical) 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 walking, stooping, bending, reaching, and carrying loads weighing up to 10 pounds is required. Data entry using a keyboard is 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 Northampton VA Medical Center 421 North Main Street Leeds, MA 01053 US
• Name: Emily Wayne-Lane
• Phone: 781-687-2000 (6764)
• Email: [email protected]