Reimbursable Billing Technician

Summary

This position is located in a Veteran Affairs Medical Center (VAMC) facility aligned with a Consolidated Patient Account Center (CPAC). The CPAC is a regionally consolidated business entity established to enhance revenue within Veterans Health Administration (VHA) using an industry best model built on regional management of key aspects of the revenue cycle, process standardization, accountability, and economies of scale.

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Overview

• Accepting applications

• Open & closing dates

06/13/2024 to 06/24/2024

• Salary

$44,117 - $63,733 per year

• Pay scale & grade

GS 6 - 7

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Locations

5 vacancies in the following locations:

• Los Angeles, CA

• San Diego, CA

• San Francisco, CA

• Remote job

No

• Telework eligible

Yes-as determined by the agency policy.

• Travel Required

Not required

• Relocation expenses reimbursed

No

• Appointment type

Permanent

• Work schedule

Full-time

• Service

Competitive

• Promotion potential

7

• Job family (Series)

0503 Financial Clerical And Assistance

• Supervisory status

No

• Security clearance

Not Required

• Drug test

No

• Position sensitivity and risk

Non-sensitive (NS)/Low Risk

• Trust determination process

Suitability/Fitness

• Announcement number

CARZ-12443162-24-DLe

• Control number

795549600

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This job is open to

• The public

U.S. Citizens, Nationals or those who owe allegiance to the U.S.

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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, you will perform assignments of a more limited scope and with less independence. You will progressively acquire the background necessary to perform at the full performance level of GS 7. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher-level work, and availability of funds.

Duties include but may not be limited to:

• Performs first (1st) and third (3rd) party facility revenue actions by identifying the type of action, verifying guideline(s) requirements, and obtaining encounter-specific information using multiple automate data delivery systems.

• Verifies the copayment status of actions and specific program requirements for care received to determine whether copayments for care outside the Agency and/or retroactive billing of copayments based on income-based exemption determinations are required.

• Cooperates with personnel within other organizational units in the wider employing organization (e.g., insurance verification, revenue utilization review, medical and prescription billing, Veteran services, denials management, outpatient pharmacy electronic claims, and/or accounts management) to solve revenue problems applicable to Veteran accounts.

• Reviews data presented from electronic or paper Explanation of Benefits (EOB)/Electronic remittance Advice (ERA) files when reviewing Veteran accounts to ensure 3rd party payments received by VA are accurately applied to Veteran accounts with 1st party copayment responsibility for the same dates of service.

• Documents account status updates, transactions, decisions, and other action for facility revenue billing and payment activities in the electronic health record system of record.

• Processes internal actions to overturn claim denials proactively or reactively from insurance carriers, care delivered outside the walls of VA through legacy/traditional systems, as well as newer programs mandated by Congress.

• Reviews outpatient encounters, inpatient admissions and discharges, long-term care visits, workers' compensation data/information, VA employee health visits, and specialty encounters to gain the requisite data necessary for 3rd party billing preparation.

• Reviews and researches veteran insurance policy coverage to prepare and process revenue billing and collection from 3rd party insurance providers.

• 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 other related duties as assigned.

Work Schedule: Fulltime, Monday-Friday, 8:00am - 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.

Financial Disclosure Report: Not Required

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Requirements

Conditions of Employment

• You must be a U.S. Citizen to apply for this job

• Selective Service Registration is required for males born after 12/31/1959

• You may be required to serve a probationary period

• Subject to background/security investigation

• Selected applicants will be required to complete an online onboarding process

• Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP)

• Participation in the Coronavirus Disease 2019 (COVID-19) vaccination program is a requirement for all Veterans Health Administration Health Care Personnel (HCP) - See "Additional Information" below for details.

Qualifications

To qualify at the GS-6 level you must meet the following:

For the GS 6 position you must possess one (1) year of specialized experience equivalent to at least next lower grade level (GS 5). Specialized experience includes but is not limited to: Providing customer service to meets the needs of the customer; Providing patient education to a diverse customer base utilizing telephone, face to face, electronic or written correspondence; Identifying, reviewing, analyzing, processing and completing co-payments and insurance encounters and other billing related activities; Reviewing and processing all specialty billing encounters; Reviewing, analyzing, researching, and verifying insurance policy coverage, filing time frames, coordination of benefits (COB) information and certification requirements for secondary billing. Note: Resume must clearly support the duties and experience required for this position. We will not make assumptions regarding experience.

To qualify at the GS-7 level you must meet the following:

For the GS 7 position you must possess one (1) year of specialized experience equivalent to at least next lower grade level (GS 6). Specialized experience includes but is not limited to: Providing customer service to meets the needs of the customer; Providing patient education to a diverse customer base utilizing telephone, face to face, electronic or written correspondence; Initiating, gathering, and processing third (3rd) party revenue actions related to legal case activities by applying appropriate and relevant guidelines; Researching and recognizing data for billing to 3rd party insurance companies using a specified patient claims information system database; Determining the best course of action for both external and internal customer co-payments, insurance and pharmacy billing and other benefit-related activities involving the use of many different methods and resources.; Providing sufficient information to determine the required or most appropriate actions to take or opt in to benefits or privileges, afforded to patients under Federal law and/or Regulations. Note: Resume must clearly support the duties and experience required for this position. We will not make assumptions regarding experience.

You will be rated on the following Competencies as part of the assessment questionnaire for this position:

• Customer Service (Clerical/Technical)

• Insurance

• Organizational Awareness

• Technical 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 primarily is sedentary, although some slight physical effort may be required. Some work may require walking, carrying light supplies/work records, utilizing telephone, fax, computer, copier and other standard office equipment. Occasional travel for training or attendance at national meetings is also 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

There is no educational substitution at the GS-6 and GS-7 grade levels.

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).

Additional information

Receiving Service Credit for Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed.

Special Employment Consideration: VA encourages persons with disabilities to apply, including those eligible for hiring under 5 CFR 213.3102(u), Schedule A, Appointment of persons with disabilities (i.e., intellectual disabilities, severe physical disabilities, or psychiatric disabilities), and/or disabled veterans with a compensable service-connected disability of 30% or more. For more information on how to apply using this appointment authority via the Selective Placement Coordinator within the office, contact the facility Human Resources Department at (702) 341-3396.

The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced Federal competitive service employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit appropriate documentation and be found well-qualified (have a final rating of 85 or more before any Veterans preference points) for this vacancy. Information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/.

This job opportunity announcement may be used to fill additional vacancies.

Pursuant to VHA Directive 1193.01, VHA health care personnel (HCP) are required to be fully vaccinated against COVID-19 subject to such accommodations as required by law (i.e., medical, religious or pregnancy). VHA HCPs do not include remote workers who only infrequently enter VHA locations. If selected, you will be required to be fully vaccinated against COVID-19 and submit documentation of proof of vaccination before your start date. The agency will provide additional information regarding what information or documentation will be needed and how you can request a legally required accommodation from this requirement using the reasonable accommodation process.

If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement.

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• Benefits

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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new window

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Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. If your resume does not support your questionnaire answers, we will not allow credit for your response(s).

Your responses to the assessment questionnaire will be reviewed along with the information provided in your resume and supporting documentation to determine if you are qualified for the position. If, after reviewing your resume and/or supporting documentation, a determination is made that you have inflated your qualifications and or experience, your rating may be lowered and/or you may lose consideration for this position. Please follow all instructions carefully. Errors or omissions may affect your eligibility.

The Department of Veterans Affairs performs pre-employment reference checks as an assessment method used in the hiring process to verify information provided by a candidate (e.g., on resume or during interview or hiring process); gain additional knowledge regarding a candidate's abilities; and assist a hiring manager with making a final selection for a position.

Candidates who apply under All U.S. Citizens announcements will be rated and ranked using Category Rating procedures. Qualified candidates will be assigned to a quality category. The categories are defined as follows:

• Best qualified - applicants possessing experience that substantially exceeds the minimum qualifications of the position including all selective factors, and who are highly proficient in all requirements of the job and can perform effectively in the position;

• Highly qualified - applicants possessing experience that exceeds the minimum qualifications of the position including all selective factors, and who are proficient in most of the requirements of the job;

• Well qualified - applicants possessing experience that meets the minimum qualifications of the position including all selective factors, and who are proficient in some, but not all, of the requirements of the job; and

• Qualified - applicants possessing experience and/or education that meets the minimum qualifications of the position including all selective factors.

Application of Veterans' Preference: Category rating and selection procedures place those with veteran's preference above non-preference eligibles within each category. Preference eligible applicants that meet the eligibility and qualification requirements and who have a compensable service-connected disability of at least 10 percent are listed in the highest quality category (except when the position being filled is scientific or professional at the GS-09 grade level or higher).

It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment.

Veterans and Transitioning Service Members: Please visit the VA for Vets site for career-search tools for Veterans seeking employment at VA, career development services for our existing Veterans, and coaching and reintegration support for military service members.