The primary function of this position is to examine and process healthcare claims, delivered to eligible beneficiaries by non-VA providers, for adjudication including determining and verifying entitlement to benefits, verifying post-entitlement actions regarding beneficiaries, and answering inquiries about benefits or procedures for filing claims.
Summary
The primary function of this position is to examine and process healthcare claims, delivered to eligible beneficiaries by non-VA providers, for adjudication including determining and verifying entitlement to benefits, verifying post-entitlement actions regarding beneficiaries, and answering inquiries about benefits or procedures for filing claims.
Who May Apply: Current Federal Employee's of the Veterans Family Member Program (VFMP) department within Delivery Operations (DO) and CTAP Eligibles. If you are not currently working for VFMP or are not a CTAP eligible and you apply, you will be rated ineligible and Out of the Area of Consideration (IAOC), and you will not be further considered for this position.
Major responsibilities include: Creates and researches accounting records to verify cost data and availability of funds; Examines accounts or resolve difficult reconciliations requiring a detailed analysis of adjustments and corrective entries in the beneficiaries' account; Trace transactions entered and prepare worksheets to reflect the source of discrepancies, corrective action required to bring billing discrepancies into agreement, prove the accuracy of discrepant data, recommend actions to prevent recurrence of similar discrepancies; Performs ancillary preparatory components of Other Health Insurance resolution responsibilities, such as manually calculating and pro-rating proper distribution of OHI payments for specific dates of services on claims for accurate payment; Annotates and distributes rejected code sheets to the technician for correction; Prepares correspondence to all parties involved, including letters transmitting adverse decisions or requests for additional information to include detailed written request to beneficiaries that are not versed in medical billing terminology, forms or SB processing requirements; Determine missing requirements and reconstruct incomplete files to allow completion of claim processing and construct letters to providers and beneficiaries; and more.
Work Schedule: An eight hour shift between 6am-4:30pm MST, based on organizational needs Telework: Available Virtual: This is not a virtual position. Position Description/PD#: Voucher Examiner/PD23533A Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not approved PCS Appraised Value Offer (AVO): Not approved Financial Disclosure Report: Not required
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 and Coronavirus Disease 2019 (COVID-19) Vaccination programs are requirements for all Department of Veterans Affairs Health Care Personnel (HCP)
Qualifications
To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 10/04/2021.
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-06 position you must have served 52 weeks at the GS-05. 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.
You may qualify based on your experience as described below:
GS-06 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:
1) Examines healthcare claims and other requests for payment for goods and services provided to Spina Bifida beneficiaries by non-VA providers
2) Examines a full range of healthcare claims having a wide variety of complicating factors to include Other Health Insurance calculations and payment authorization
3) Enters payment information into a computerized healthcare claims payment processing system which is applicable to the claim type, and program type unless internal or external correspondence is required
4) Examines all claims to ensure necessary processing information is present or suspends/rejects claim to appropriate queue
5) Analyzes each claim submission to determine propriety of payment to include required certifications by authorized officials, compliance with contract provisions, price agreements, and/or other directive material
You will be rated on the following Competencies for this position:
Arithmetic/Mathematical Reasoning
Clinical Data Collection/Documentation
Computer Skills
Insurance
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: Long periods of sitting in one location are required in completing transactions, using a
computer with dual monitors as well as other standard office equipment. Work is performed in an office setting, but one that is considerably noisier and stressful than a typical office. After meeting requirements teleworking may be a consideration.
There is no educational substitution at this grade level.
Additional information
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.
The Career Transition Assistance Plan (CTAP) provides eligible displaced Federal/VA competitive service employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit appropriate documentation (a copy of the agency notice, your most recent performance rating, and your most recent SF-50 noting current position, grade level, and duty location) and be found well-qualified for this vacancy. To be well-qualified: applicants must possess experience that exceeds the minimum qualifications of the position including all selective factors, and who are proficient in most of the required competencies of the job. Information about 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/.
Placement Policy: The posting of this announcement does not obligate management to fill a vacancy or vacancies by promotion. The position may be filled by reassignment, change to lower grade, transfer, appointment, or reinstatement. Management may use any one or any combination of these methods to fill the position.
It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment.
This job opportunity announcement may be used to fill additional vacancies.
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.
If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.
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 windowLearn more about federal benefits.
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.
Narrative responses are not required at this time. If you are referred for consideration, you may be asked to submit additional job related information, which may include, but not limited to; responses to the knowledge, skills and abilities; completion of a work sample, and/or contact for an interview.Your resume and/or supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect your rating or consideration for employment.
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 windowLearn more about federal benefits.
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.
To apply for this position, you must provide a complete Application Package which includes:
Resume
SF-50/ Notification of Personnel Action
The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this position. Please use this checklist to make sure you have included other documents required for your application, such as a copy of your transcript (if using education to qualify), SF-50's (current/former Federal employees), documentation to support Veterans Preference claims, or ICTAP/CTAP documentation (for displaced Federal employees). You will not be contacted for additional information.
Cover Letter
OF-306
Other
Performance Appraisal
Resume
Separation Notice (RIF)
SF-50/ Notification of Personnel Action
SF-50, Notification of Personnel Action (if applicable for Time in Grade and/or Eligibility):
Most recent SF-50 if you are a current or former Federal employee
An SF-50 showing 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
Award 50's do not provide sufficient information and will not be accepted for the purpose of verifying time-in-grade.
Examples of appropriate SF-50's include:
Within grade increases at the highest grade held; or
Promotions with an effective date more than one year old; or
SF-50's at the highest grade held with an effective date more than one year old.
Veterans' Preference: When applying for Federal Jobs, eligible Veterans should claim preference for 5pt (TP), 10pt (CP/CPS/XP), or for Sole Survivor Preference (SSP) in the questionnaire. You must provide a legible copy of your DD214(s) which shows dates and character of service (honorable, general, etc.). If you are currently serving on active duty and expect to be released or discharged within 120 days you must submit documentation related to your active duty service which reflects the dates of service, character of service (honorable, general, etc.), and dates of impending separation. Additionally, disabled veterans and others eligible for 10-point preference (such as widows or mothers of eligible Veterans) must also submit an SF-15 "Application for 10 Point Veteran Preference" with required proof as stated on the form. Documentation is required to award preference. For more information on Veterans' Preference, please visit Feds Hire Vets - Veterans - Job Seekers - Veterans' Preference.
All applicants are encouraged to apply online. To apply for this position, you must complete the questionnaire and submit the documentation specified in the Required Documents section below. The complete application package must be submitted by 11:59 PM (ET) on 10/04/2021 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/11226349.
To begin, click Apply Online to create a USA JOBS account or log in to your existing account. Follow the prompts to select your USA JOBS resume and/or other supporting documents and complete the occupational questionnaire.
Click Submit My Answers to submit your application package.
NOTE: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.
To verify your application is complete, log into your USA JOBS account, https://my.usajobs.gov/Account/Login, select the Application Status link and then select the more information link for this position. The Application page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process. To return to an incomplete application, log into your USA JOBS account and click Update Application in the vacancy announcement. You must re-select your resume and/or other documents from your USA JOBS account or your application will be incomplete.
NOTE: Participation in the seasonal influenza and Coronavirus Disease 2019 (COVID-19) Vaccination programs are requirements for all Department of Veterans Affairs Health Care Personnel (HCP). Participation in the seasonal influenza program is a condition of employment. It is a requirement that all HCP receive the COVID-19 vaccination and annual seasonal influenza vaccination or obtain an exemption for medical or religious reasons. Wearing a face mask is required when an exemption has been granted. HCP in violation of these directives may face disciplinary action up to and including removal from federal service
HCP for purposes of the influenza vaccination program are individuals who, during the influenza season, work in VHA locations or who come into contact with VA patients or other HCP as part of their duties. VHA locations include, but are not limited to, VA hospitals and associated clinics, community living centers (CLCs), community-based outpatient clinics (CBOCs), domiciliary units, Vet centers and VA-leased medical facilities. HCP include all VA licensed and unlicensed, clinical and administrative, remote and onsite, paid and without compensation, full- and part-time employees, intermittent employees, fee basis employees, VA contractors, researchers, volunteers and health professions trainees (HPTs) who are expected to perform any or all of their work at these facilities. HPTs may be paid or unpaid and include residents, interns, fellows and students. HCP also includes VHA personnel providing home-based care to Veterans and drivers and other personnel whose duties put them in contact with patients outside VA medical facilities.
HCP for purposes of the COVID-19 vaccination program refers to all paid and unpaid persons who work in or travel to VHA locations who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. These HCP may include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, health professions trainees (HPTs), contractor personnel, and persons (e.g., clerical, dietary, environmental services, laundry, security, maintenance, engineering and facilities management, administrative, billing, and volunteer personnel) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted from HCP and patients. HCP include all VA licensed and unlicensed, clinical and administrative, paid and without compensation, full- and part-time, intermittent, fee basis employees who are expected to perform any or all of their work at these locations. HCP also includes VHA personnel and contractor personnel providing home-based care to Veterans and drivers and other personnel whose duties put them in contact with patients outside VA medical facilities.
Workforce Management - Community Care
120 SE 6th Street Suite 102
Topeka, KS 66603
US
Next steps
Once your online application is submitted you will receive a confirmation notification by email. After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email. Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made.
You may check the status of your application at any time by logging into your USA Jobs account and clicking on Applications. Information regarding your application status can be found in the USAJobs Help Center.
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
To apply for this position, you must provide a complete Application Package which includes:
Resume
SF-50/ Notification of Personnel Action
The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this position. Please use this checklist to make sure you have included other documents required for your application, such as a copy of your transcript (if using education to qualify), SF-50's (current/former Federal employees), documentation to support Veterans Preference claims, or ICTAP/CTAP documentation (for displaced Federal employees). You will not be contacted for additional information.
Cover Letter
OF-306
Other
Performance Appraisal
Resume
Separation Notice (RIF)
SF-50/ Notification of Personnel Action
SF-50, Notification of Personnel Action (if applicable for Time in Grade and/or Eligibility):
Most recent SF-50 if you are a current or former Federal employee
An SF-50 showing 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
Award 50's do not provide sufficient information and will not be accepted for the purpose of verifying time-in-grade.
Examples of appropriate SF-50's include:
Within grade increases at the highest grade held; or
Promotions with an effective date more than one year old; or
SF-50's at the highest grade held with an effective date more than one year old.
Veterans' Preference: When applying for Federal Jobs, eligible Veterans should claim preference for 5pt (TP), 10pt (CP/CPS/XP), or for Sole Survivor Preference (SSP) in the questionnaire. You must provide a legible copy of your DD214(s) which shows dates and character of service (honorable, general, etc.). If you are currently serving on active duty and expect to be released or discharged within 120 days you must submit documentation related to your active duty service which reflects the dates of service, character of service (honorable, general, etc.), and dates of impending separation. Additionally, disabled veterans and others eligible for 10-point preference (such as widows or mothers of eligible Veterans) must also submit an SF-15 "Application for 10 Point Veteran Preference" with required proof as stated on the form. Documentation is required to award preference. For more information on Veterans' Preference, please visit Feds Hire Vets - Veterans - Job Seekers - Veterans' Preference.
All applicants are encouraged to apply online. To apply for this position, you must complete the questionnaire and submit the documentation specified in the Required Documents section below. The complete application package must be submitted by 11:59 PM (ET) on 10/04/2021 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/11226349.
To begin, click Apply Online to create a USA JOBS account or log in to your existing account. Follow the prompts to select your USA JOBS resume and/or other supporting documents and complete the occupational questionnaire.
Click Submit My Answers to submit your application package.
NOTE: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.
To verify your application is complete, log into your USA JOBS account, https://my.usajobs.gov/Account/Login, select the Application Status link and then select the more information link for this position. The Application page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process. To return to an incomplete application, log into your USA JOBS account and click Update Application in the vacancy announcement. You must re-select your resume and/or other documents from your USA JOBS account or your application will be incomplete.
NOTE: Participation in the seasonal influenza and Coronavirus Disease 2019 (COVID-19) Vaccination programs are requirements for all Department of Veterans Affairs Health Care Personnel (HCP). Participation in the seasonal influenza program is a condition of employment. It is a requirement that all HCP receive the COVID-19 vaccination and annual seasonal influenza vaccination or obtain an exemption for medical or religious reasons. Wearing a face mask is required when an exemption has been granted. HCP in violation of these directives may face disciplinary action up to and including removal from federal service
HCP for purposes of the influenza vaccination program are individuals who, during the influenza season, work in VHA locations or who come into contact with VA patients or other HCP as part of their duties. VHA locations include, but are not limited to, VA hospitals and associated clinics, community living centers (CLCs), community-based outpatient clinics (CBOCs), domiciliary units, Vet centers and VA-leased medical facilities. HCP include all VA licensed and unlicensed, clinical and administrative, remote and onsite, paid and without compensation, full- and part-time employees, intermittent employees, fee basis employees, VA contractors, researchers, volunteers and health professions trainees (HPTs) who are expected to perform any or all of their work at these facilities. HPTs may be paid or unpaid and include residents, interns, fellows and students. HCP also includes VHA personnel providing home-based care to Veterans and drivers and other personnel whose duties put them in contact with patients outside VA medical facilities.
HCP for purposes of the COVID-19 vaccination program refers to all paid and unpaid persons who work in or travel to VHA locations who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. These HCP may include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, health professions trainees (HPTs), contractor personnel, and persons (e.g., clerical, dietary, environmental services, laundry, security, maintenance, engineering and facilities management, administrative, billing, and volunteer personnel) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted from HCP and patients. HCP include all VA licensed and unlicensed, clinical and administrative, paid and without compensation, full- and part-time, intermittent, fee basis employees who are expected to perform any or all of their work at these locations. HCP also includes VHA personnel and contractor personnel providing home-based care to Veterans and drivers and other personnel whose duties put them in contact with patients outside VA medical facilities.
Workforce Management - Community Care
120 SE 6th Street Suite 102
Topeka, KS 66603
US
Next steps
Once your online application is submitted you will receive a confirmation notification by email. After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email. Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made.
You may check the status of your application at any time by logging into your USA Jobs account and clicking on Applications. Information regarding your application status can be found in the USAJobs Help Center.
Fair and transparent
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
