This is a position located within the Community Care service of the Washington DC VA Medical Center (DC VAMC). DC VAMC is a highly complex multi-divisional tertiary care, extended care, and teaching medical center. Community Care is a comprehensive program that is responsible for the administrative daily operational management of non-VA authorized and unauthorized medical care.

Duties

Duties of the position include but not limited to the following: Responsible for all tasks involved in managing obligation fund control points and ensures all activities are recorded timely, accurately, and balances are reconciled. Reviews and analyzes community care authorizations and payments within several software portals including but not limited to FBCS, FMS, Vista, DOMA and VSSC, Care point and SharePoint. Includes analysis of DOD Exception and Payment Reviews. Assures the development of data and long-term budget formulation. Gathers and analyzes financial data concerning current and future state of program operations to include project costs based on current trends and review of historical data. Forecasts shortfalls/excesses within the program and proposes actions to accommodate those changes. Projects costs, analyzes workload and trends for possible adjustment. Performs audits of payments made ensuring accuracy; provides tracking to confirm corrections are made and bills of collection are issued when appropriate. Maintains timecards, initiates personnel actions and overtime actions, and ensures appropriate personnel actions are done on a timely basis for the supervisor's subordinate staff. Serves as the timekeeper for assigned T&Ls. Takes notes and transcribes personal and telephone conversations. Completing Secure messaging correspondence in myhealthevet. Coordination: Works closely with VISN Community Care Budget Department as well as DC VAMC Fiscal with respect to financial matters and budgetary issues as they impact Community Care at the local level. Responsible for establishing and updating, at the Austin Automation Center, vendor information (process known as vendorizing) to include social and demographic data, medical specialty code and tax identification numbers for all NVCC/Fee programs (non-VA hospitalization, outpatient medical, dental, dialysis, and pharmacy). Works with POM to answer questions, provide resolution, seek assistance, provide information, support, and otherwise act on behalf of Community Care to solve billing and claims problems. Budgetary Assistance: Exercises initiative and resourcefulness in researching and implementing new methods of planning for and estimating budgetary needs. Provides assistance to management on all aspects of the interpretation and application of agency guidelines for the budget execution process to the program. Claims and Payment Research and Analysis: Researches claims and payments questions from community providers and Veterans. Analyzes authorizations and claims issues to provide guidance to Community Care staff, Veterans, and community providers. Customer Service and Education: Coordination and Management of State Home Program: Provides assistance to community providers with respect to appropriate billing procedures and troubleshooting. Serves as service level subject matter expert on billing, claims and payment for education and training of Community Care staff. Serves as a subject matter expert to answer veteran and provider questions regarding billing and payment, including by phone, by secure message, by email and in response to PATS-R and EV complaints. Coordinates the State Home program. Tracks veteran movement throughout community nursing homes and assisted living. Responsible for determining appropriate billing rate based on veteran's eligibility. Responsible for processing State Home applications within 10 calendar days. Updates the State Home electronic tracking tool weekly for purposes of payment. Promotion Potential: The selectee may be promoted to the full performance level 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 08:00am - 4:30 pm 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. Position Description/PD#: Program Specialist/PD21033O Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Authorized Permanent Change of Station (PCS): Not Authorized Whole Health is an approach to health care that empowers and equips people to take charge of their health and well-being and live their life to the fullest. The VA is committed to Whole Health and values Veteran and Employee health and wellbeing. As a VA employee, you will practice Whole Health in an environment that supports personalized and proactive care.

Requirements

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 01/07/2025. 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-07 position you must have served 52 weeks at the GS-05. For a GS-09 position you must have served 52 weeks at the ???????GS-07. 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: Program Specialist GS-07 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: ???????Responsible for all tasks involved in managing obligation fund control points and ensures all activities are recorded timely, accurately, and balances are reconciled. Responsible for establishing and updating, at the Austin Automation Center, vendor information to include social and demographic data, medical specialty code and tax identification numbers for all NVCC/Fee programs. Responsible for forecasting shortfalls/excesses within the program and proposes action to accommodate those changes. Project costs, analyzes workload and trends for possible adjustment. Works with POM to answer questions, provide resolution, seek assistance, provide information, support, and otherwise act on behalf of Community Care to solve billing and claims problems. OR, Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have one full year of graduate level education or superior academic achievement. OR, Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education. Program Specialist GS-09 Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-07 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Responsible to review and analyze community care authorizations and payments within several software portals including but not limited to FBCS, FMS, Vista, DOMA, VSSC, CarePoint, and SharePoint. This includes analysis of DOD Exception and Payment Reviews. Gathers and analyzes financial data concerning current and future state of program operations to include project costs based on current trends and review of historical data. Researches claims and payments questions from community providers. Serve as a service level subject matter expert on billing, claims and payment for education and training of Community Care staff. ???OR, Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related OR, Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education. You will be rated on the following Competencies for this position: Administration and ManagementDecisivenessKnowledge ManagementProblem Solving 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 typically sedentary, although some slight physical effort may be required, such as carrying printouts, books, etc.For more information on these qualification standards, please visit the United States Office of Personnel Management's website at 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 Washington VA Medical Center 50 Irving Street, Northwest Washington, DC 20422 US
• Name: James Caine
• Phone: 503-459-2594
• Email: [email protected]