Contact Representative

Full Job Description

About the Position: Serves as a Contact Representative, a beneficiary advocate and advisor providing service and assistance to Military Health System beneficiaries in understanding and obtaining benefits via the TRICARE program.

Serves as a Beneficiary Counseling and Assistance Coordinator and Debt Collection Assistance Officer at Naval Station, Oceana, Virginia.

Who May Apply: Only applicants who meet one of the employment authority categories below are eligible to apply for this job.

You will be asked to identify which category or categories you meet, and to provide documents which prove you meet the category or categories you selected.

Current Civilian Employees of the Defense Health Agency (DHA) Current Permanent Department of Defense (DoD) Civilian Employee Domestic Defense Industrial Base/Major Range and Test Facilities Base Civilian Personnel Workforce Interagency Career Transition Assistance Plan Land Management Workforce Flexibility Act Military Spouses, under Executive Order (E.O.) 13473 Priority Placement Program, DoD Military Reserve (MR) and National Guard (NG) Technician Eligible Priority Placement Program, DoD Military Spouse Preference (MSP) Eligible Priority Placement Program, DoD MR and NG Preference Eligible Tech Receiving Disability Retirement Priority Placement Program, DoD Retained Grade Preference Eligible Veterans Employment Opportunity Act (VEOA) of 1998 In order to qualify, you must meet the experience requirements described below.

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).

You will receive credit for all qualifying experience, including volunteer experience.

Your resume must clearly describe your relevant experience; if qualifying based on education, your transcripts will be required as part of your application.

Additional information about transcripts is in this document.

GS-6 Grade Level: Specialized Experience: One year of specialized experience which includes 1) perform referral screening and appointing for referrals, 2) ensure all specialty referrals are screened, processed and appointed in accordance with local policies, 3) receive incoming calls and walk-in visits from patients, and 4) enrollment processing.

This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-05).

Time in Grade Requirement: Applicants who have held a General Schedule (GS) position within the last 52 weeks must have 52 weeks of Federal service at the next lower grade or equivalent (GS-05).

GS-7 Grade Level: Specialized Experience: One year of specialized experience which includes 1) answer routine questions from beneficiaries related to medical insurance claims, such as submission, collections, and case resolution processes, 2) assist with counseling beneficiaries on a broad range of healthcare related benefits, and 3) utilize automated healthcare database to enter and retrieve patient data.

This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-06).

Time in Grade Requirement: Applicants who have held a General Schedule (GS) position within the last 52 weeks must have 52 weeks of Federal service at the next lower grade or equivalent (GS-06).

GS-8 Grade Level: Specialized Experience: One year of specialized experience which includes 1) assist beneficiaries by resolving or correcting discrepancies of existing medical claims, 2) provide regulatory healthcare guidance to the patient population on their rights, benefits, privileges, access to care and available eligibilities, 3) counsel beneficiaries on a broad range of available health benefit programs, and 4) utilize an automated healthcare database to enter and retrieve patient data.

This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-07).

Time in Grade Requirement: Applicants who have held a General Schedule (GS) position within the last 52 weeks must have 52 weeks of Federal service at the next lower grade or equivalent (GS-07).

Major Duties:

• Provide beneficiary counseling and assistance to ensure health benefit information is available to eligible beneficiaries.
• Act as liaison to assist beneficiaries regarding the TRICARE program, coordinating with medical staff, Tricare Area office service centers, Managed Care Support Contractors, claims processor, and other concerned parties.
• Coordinate briefings for the servicing community to include active duty, family members, newcomers, pre-deployment and post deployment.
• Utilize various healthcare software applications to verify patient eligibility and complete patient enrollment.
• Track medical claim cases using a system to categorize caseload by data elements for timely resolution.
• Develop recommendations to change or modify existing procedures or policies that will subsequently provide more effective and improved health care to the beneficiary category populations.
• Provide information to resolve problems involving access, payment of bills, and eligibility issues concerning medical care under the TRICARE program.
• Interview or counsel customers.