Job opening: Supervisory Program Specialist
Salary: $59 966 - 77 955 per year
Published at: Dec 30 2024
Employment Type: Full-time
This position is located in a Consolidated Patient Account Center (CPAC) in the organization of the Chief Operating Officer (COO) with the incumbent serving as a Health Insurance Officer. The CPAC is a regionally consolidated business entity established to enhance revenue operations throughout the VHA network by standardization and consolidation of functions, and the integration of VHA and industry best practices.
Duties
Duties include and are not limited to:
Provides management guidance, direction and supervision to the CPAC's Insurance Verification program operations.
Implements processes and procedures for staff to contact insurance carriers to ascertain all benefits the veteran or policyholder is entitled to under his/her health insurance plan.
Assures that staff analyzes, interpret and insure timely input of all information gathered during phone conversation with insurance carrier representatives into the VA insurance database.
Monitors the integrity of the insurance file database by ascertaining that data is timely and accurate.
Reviews and evaluates insurance data to determine the necessity to merge like insurance plans and/or companies and/or to add new insurance plans/companies.
Analyzes insurance information and data to determine, when appropriate, to delete outdated insurance plans and/or companies, taking all necessary steps to insure valid data is merged/saved prior to deletion.
Provides guidance and assistance for the review of Explanation of Benefits (EOB) as necessary to identify insurance information.
Researches Third Party Joint Inquiry files for prior payments.
Reviews Claims Tracking files for proper pre-certification.
Examines patient insurance files for accurate/current data.
Work Schedule: Monday - Friday, 8:00 AM - 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.
Virtual: This is not a virtual position.
Position Description/PD#: Supervisory Program Specialist/PD73105A
Relocation/Recruitment Incentives: Not Authorized
Critical Skills Incentive (CSI): Not Approved
Permanent Change of Station (PCS): Not Authorized
Qualifications
To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 01/09/2025.
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-9 position you must have served 52 weeks at the GS-7. 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 GS-7 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Examines patient insurance files for accurate/current data. Implements processes and procedures for staff to contact insurance carriers. Identifies training and development requirements. Reviews and evaluates insurance data. Monitors the integrity of an insurance file database by ascertaining that data is timely and accurate. OR,
Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have ???????a 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 beyond 1 year (18 semester hours) towards a master's degree, the first 18 credits will not apply towards combination.
You will be rated on the following Competencies for this position:
Insurance: Knowledge of various types of insurance, insurance regulations, claims processing, examination, adjudication, or adjustment.
Administration and Management: Knowledge of planning, coordination, and execution of business functions, resource allocation, and production.
Communication: Expresses information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information (for example, technical, sensitive, controversial); makes clear and convincing presentations; listens to others, attends to nonverbal cues, and responds appropriately.
Technical Competence: Understands and appropriately applies procedures, requirements, regulations, and policies related to specialized expertise (for example, engineering, physical science, law, or accounting); maintains credibility with others on technical matters.
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 performed mainly in a sedentary manner; however, walking, standing, reaching, and bending 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 Mid South Consolidated Patient Accounts Center
1412 Hazelwood Dr
Smyrna, TN 37167
US
- Name: VHA National Recruitment Center
- Phone: (844)456-5208
- Email: [email protected]
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