Clarification from the agency

Open to current, permanent employees of the Veterans Health Administration and CTAP eligible applicants. This is not open to the public.

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• Serves as the local CPAC's technical authority on the VHA's Insurance Verification, Pre-registration and Pharmacy Claims Processing departments and the interface with intake business processes at the medical center.
• Directs the development of the most critical and complex MCCF diagnostic measures reporting mechanisms to showcase
  and spotlight areas in need of improvement, or areas that have excelled in reporting.
• Advises the CPAC Program Managers' of potential areas of concern and process breakdowns impacting insurance data capture and pharmacy claims processing with recommendations for improvement.
• Implements and manages all aspects of insurance verification activities for CPAC clients including the E-IIV program, contractor sourced new insurance uploads, routine verification and re-verification of patient specific insurance coverage: pre-registration of patients with scheduled admissions and ambulatory procedures prior to appointment, processing (data entry and verification) of newly identified insurance card data and the entire pharmacy claims processing including; billing, EOB review, accounts follow-up and closure.
• Provides management oversight, guidance, and direction for monitoring activities designed to ensure the integrity and accuracy of insurance information contained on healthcare claims.
• Develops, implements, and evaluates management procedures in order to enhance provider relations and productivity. Performs analysis of workload, patient service, and similar data to forecast future needs of the CPAC and initiates the necessary action to ensure efficient service delivery.
• Establishes and maintains effective working relationships with others throughout the organization as well as externally. These include high ranking Department of Veterans Affairs officials, officials of other Government agencies, members of the public as well as colleagues and subordinates.
• Plans work to be accomplished by subordinates, and establishes and adjusts long and short term priorities and deadlines. Assigns work based upon program priorities, capabilities, and assignment requirements. Establishes standards for the performance of work. Conducts periodic evaluations of the work performance of subordinates. Provides advice, counsel or instructions to employees on administrative and technical matters.
• Designs, plans, schedules and conducts studies and organizational strategies to identify opportunities to improve customer service and quality. Facilitates the innovative application of industry and agency best practices and quality management methods. Performs other directly related duties as assigned.

Work Schedule: Monday - Friday, 8:00 am - 4:30 pm
Compressed/Flexible: May be available at supervisors discretion
Telework: This position may be authorized for telework. Telework eligibility will be discussed during the interview process.
Virtual: This is not a virtual position.
Financial Disclosure Report: Not required

Conditions of employment

As a condition of employment for accepting this position, you will be required to serve a 1-year probationary period (OR INSERT "2-year trial period") during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider:

• your performance and conduct;
• the needs and interests of the agency;
• whether your continued employment would advance organizational goals of the agency or the Government; and
• whether your continued employment would advance the efficiency of the Federal service.

Upon completion of your probationary period (OR INSERT "trial period"), your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.

• You must be a U.S. Citizen to apply for this job
• Selective Service Registration is required for males born after 12/31/1959
• Physical Requirements: The work required does not inherently include any physical requirements essential for successful job performance that could not otherwise be performed with accommodation or workplace adjustment. A pre-placement physical examination is not required.
• Subject to background/security investigation
• Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
• As a condition of employment for accepting this position, you will be serving in a position in Schedule Policy/Career of the excepted service. You will obtain competitive status after two years of service in this position, if applicable.
• Effective May 7, 2025, driver's licenses or state-issued dentification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 09/21/2026.

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-11 position you must have served 52 weeks at the GS-9. 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-9 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to:
  • Managing or coordinating insurance verification and/or pharmacy claims processing activities, including pre-registration, eligibility verification, or accounts receivable follow-up in a healthcare or medical billing setting. Applying federal healthcare regulations, statutes, or agency policy (e.g., VHA revenue cycle directives, Tricare/CHAMPVA billing requirements) to analyze and resolve program or compliance issues.
  • Analyzing financial or program data (e.g., billing, collections, or accounts receivable reports) to identify trends, measure performance, and develop recommendations for improving revenue cycle or program operations.
  • Developing or implementing management studies, procedures, or internal controls to improve organizational effectiveness in a financial administration or revenue operations program.
  • Supervising, leading, or providing technical direction to staff performing financial, administrative, or claims-processing work, including assigning work, evaluating performance, and identifying training needs.
  • Preparing and presenting complex reports or data to management or leadership (e.g., performance metrics, diagnostic measures, quality assurance findings) to support decision-making.
  • Communicating with internal and external stakeholders (e.g., insurance carriers, medical center leadership, VISN or network officials) to resolve disputes, negotiate compliance, or coordinate program activities.

• Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have Ph.D. or equivalent doctoral degree or 3 full years of progressively higher level graduate education leading to such a degree or LL.M., 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 to qualify at the GS-11. This can be determined by adding total qualifying experience as a percentage of the required experience and education as a percentage of the total required. The total percentage must equal 100 percent. Only education more than the first 18 semester hours (i.e. beyond the first-year graduate level education) is creditable towards meeting the specialized experience requirement. A transcript must be submitted with your application if you are basing all or part of your qualifications on education.

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 primarily sedentary, although some slight physical effort may be required.

For more information on these qualification standards, please visit the United States Office of Personnel Management's website at http://://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.

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.