The Reimbursement Technician position is in the Office of Chief Operating Officer (COO), Consolidated Patient Account Center (CPAC), VHA Office of Finance, Revenue Operations, Facility Revenue Division, Veterans Health Administration, Department of Veterans Affairs, in Las Vegas, NV.

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, the individual performs assignments of a more limited scope and with less independence. The individual will progressively acquire the background necessary to perform at the full performance level of GS-7. Duties can include, but are not limited to: Revenue Generation and Reconciliation Activities: 3rd Party Billing Preparation and 1st Party Billing Creation Dual Role: Performs first (1st) and third (3rd) party facility revenue actions by identifying the type of action, verifying guidelines(s) requirements, and obtaining encounter-specific information using multiple automated data delivery systems. Determines the 1st party copayment eligibility, the FRT then determines the appropriate amount of a copayment charge based on the level of care provided. Receives workload from multiple worklist systems, electronic, and mail notification, VA specific internal and external data applications, emails, letter, and face-to-face customer service interactions. 3rd Party Billing Preparation: Accesses, reviews, operates, and processes various revenue specific systems, procedures, transactions, reports, and action to identify, verify completeness and accuracy, locate missing data and/or information, process, and complete 3rd party billing encounter transactions and revenue-related activities for the purposes of VA revenue generation. Reviews and researches Veteran insurance policy coverage to prepare and process revenue billing and collection from 3rd party insurance providers. 3rd Party Specialty Billing Preparation: 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 preparation and review activities for specialty-specific 3rd party billing areas requiring proactive reviews and actions to prevent denials from insurance carriers as part of the revenue cycle. Reviews prosthetics, dialysis, ambulance care, humanitarian, and potential legal encounters within specialized billing and payment processing systems for those types of encounters and gathers necessary data points for 3rd party billing for revenue collections from 3rd party insurance carriers. 3rd Party Denials Management: Uses thesedata delivery applications and information employing VA-specific methods to transferdata to proprietary bill preparation systems for clean claims billing to 3rd party insurancecompanies. Updates information within the National Plan and Provider Enumeration System (NPPES), 3rd party insurance company-specific provider identification systems, Healthcare Common Procedure Coding System (CPT/HCPCS), and various websites. Privacy, Security, Release of Information and Safeguarding Date: Reviews designated data in delivery and tracking systems to enter disclosures of records subject to the provisions of applicable guidelines (e.g., 38 CFR 1.576(c), 45 CFR 162.528) into a VA designated Accounting of Disclosure (AOD) information database. Reviews medical records documentation and identifies protected sensitive diagnosis and CPT codes related to sensitive and Federally protected health care conditions. 1st Party Billing Specific Duties: Corrects retroactively exempt or incorrectly billed charges through internally and externally generated workload reviews from multiple data sources. Reviews charges to determine whether copayments should be released to Veterans or cancelled due to duplicate copayment charges for existing copayment events. Performs manual billing of 1st party medication charges (i.e., specifically for instances of medication prescriptions filled outside the VA pharmacy system but paid for by VA as part of VA care programs. Veterans Customer Service - Benefits and VA Specific Eligibility Requirements: Works with other CPAC organizations, VA Health Resource Center (HRC), and VA Regional Counsel representatives on questions and corresponding corrective actions regarding VA 1st or 3rd party billing issues, questions, and similar actions. Researches and communicates solution options available to Veteran customers related to all categories of 1st and 3rd party revenue problems. Work Schedule: Monday - Friday; 8am to 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.

Requirements

Qualifications

***Note: Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher-level work, and availability of funds. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher-level work, and availability of funds.*** ENGLISH LANGUAGE PROFICIENCY: In accordance with 38 U.S.C. 7402(d), No person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. You must be proficient in basic written and spoken English in order to meet the requirements of this position. AND SPECIALIZED EXPERIENCE GS-6: Applicants must have at least one (1) year of specialized experience that equipped them with the particular knowledge, skills, and abilities to perform successfully the duties of this position, and that is typically in or related to the work of this position. To be creditable, this experience must have been equivalent to at least the GS-5 level in the Federal service. Specialized experience includes: providing accurate and timely billing and collection activities to be completed in accordance within prescribed policies, regulations and laws; performing analysis of complex problems; gathering and collecting the necessary information; establishing the facts and taking or recommending actions based upon the application or interpretation of established guidelines; using independent judgment to best assist patients/customers and coming to a resolution regarding their patient/customer billing, eligibility, insurance and care and/or services provided. OR SPECIALIZED EXPERIENCE GS-7: Applicants must have at least one (1) year of specialized experience that equipped them with the particular knowledge, skills, and abilities to perform successfully the duties of this position, and that is typically in or related to the work of this position. To be creditable, this experience must have been equivalent to at least the GS-6 level in the Federal service. Specialized experience includes: providing accurate and timely billing and collection activities; researching, analyzing, generating and correcting patient co-payment bills and insurance for care as it pertains to a variety of healthcare programs and services.; using independent judgment to best assist patients/customers and coming to a resolution regarding their patient/customer billing, eligibility, insurance and care and/or services provided; performing analysis of complex problems; and performing daily reviews, audits, and/or corrective actions. 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 is performed mainly in a sedentary manner. Occasional walking, standing, reaching, and bending are required. The carrying of light item such as paper, folders, and files between desk and storage is common. The work requires long periods of interaction at computer terminals. 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

IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on 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: Recognition of Foreign Qualifications | International Affairs Office (ed.gov).

Contacts

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