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The incumbent serves as a Health Benefits Advisor for the Community Care Administrative side within the Community Care service, in conjunction with Non-VA Coordinated Care (NVCC) and Veterans Choice Act (VCA) Programs, and Office of Community Care Programs. The employee is responsible for the legality and propriety, eligibility determination and payments process for all programs.
The incumbent is the primary resource for the VCA process to ensure Veterans who meet eligibility for the program have access to the benefit. The incumbent will also assist Veterans and vendors seeking services or payments/reimbursement for services provided under Community Care and VCA as applicable. The incumbent is responsible for managing their share of these programs on a daily basis. They are fully responsible for developing and processing requests for authorization of Community Care services including but not limited to: NVCC, VCA Programs, examining vouchers (claims for payment), certifying vouchers for payment, and entering/submitting certified vouchers into a centralized automated system. They are also responsible for researching issues to resolve problems that may arise with regard to service provided or received under all programs, such as basic eligibility or veteran status, service connected disability, vouchers rejected by the automated financial system, etc. The incumbent deals with questions and claims for both authorized and unauthorized services.The incumbent determines and verifies eligibility, applies program criteria, assembles the NVCC records, authorizing the service (including coordination with appropriate VA and Non-VA medical center officials). When vendors submit a claim, the incumbent examines it to assure the bills are for the services authorized and at the appropriate rate, and certify the voucher for payment by verifying accuracy of all invoices to include mathematical, authorized, vendorized and coding. The incumbent suspends amounts claimed on vouchers/invoices that are incorrect, illegal, improper or excessive. Initiates correspondence, cites the authorities supporting suspension and informs the claimant of vendor of recourse, if any, for submitting reclaim. Provides "on the job" training for entry level employees in Community Care Administrative Section. Must respond to numerous inquiries from Veterans, vendors, station employees, Veterans Integrated Networks System (VISN), and National VA officials concerning the status of NVCC and VCA consults to authorization process, payment or invoices.
Work Schedule:Monday - Friday (8:00 am - 4:30 pm)
Compressed/Flexible: Not Available
Telework: Maybe available
Virtual: This is NOT a virtual position.
Position Description/PD#: Voucher Examiner /11472-A
Relocation/Recruitment Incentives: Not Authorized
Financial Disclosure Report: Not required
Job family (Series)
This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/GetJob/ViewDetails/522591800. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered.