Contact Representative

Full Job Description

The purpose of the position is to serve as a Health Benefits Unit Contact Representative, to the Health Administration Service (HAS), under the direct supervision of the Supervisory Medical Administrative Specialist.

This position is responsible for a wide range of assignments and provides administrative support to the Section, and the cost recovery aspects of this position have a direct impact on the reimbursement of the facility.

To qualify for this position at the GS-6 level, you must meet the following requirement: Experience: For the GS-6 grade level you must possess at least one (1) full year of specialized experience that has equipped you with the knowledge, skills, and abilities to perform the duties of the position, GS-6 as described below.

To be creditable, this experience must have been equivalent to at least the GS-5 grade level in the Federal Service.

Specialized experience includes: providing customer service support, receiving inbound and making outbound telephone calls with multiple customers; receiving and reviewing benefit applications; preparing correspondence; and processing requests to update customer/patient information in a computerized database.

NOTE: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week.

Physical Demands: This is primarily a sedentary position, but the work requires some walking, bending, stooping and carrying of light objects such as manuals, documents, etc.

Concentration and sustained performance under prolonged stress is required because of the time factors involved in completion of work assignments within deadlines.

Work Environment: Works in an office/clinical setting. Work areas are generally adequate and shared. Occasional travel is required.

He/she frequently walks to and interacts with other services throughout the facility and Community Based Outpatient Clinics.

The incumbent observes established safety standards and practices as defined in the facility's policies and guidelines.

May also occasionally work outside the Veterans Affairs (VA) to participate in community events such as Health Fairs, Homeless Veterans Stand Downs and Post Deployment Health Re-assessment (PDHRA).

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.

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/.

Major 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.

As a Health Benefits Contact Representative, the incumbent serves as the subject-matter expert and is responsible for applying an extensive body of rules and regulations relative to Veterans Eligibility for Veterans Affairs (VA) healthcare benefits, interpretation of relevant laws, Veterans Health Administration (VHA) guidelines and regulations, and other federal agency policies is required to ensure that timely and appropriate measures are taken throughout data collection and data entry processes.

Processing requests to update veterans personal, eligibility and enrollment information, entering demographic, insurance, and income information, into the Vista and Veteran Enrollment System (VES).

Adjudicating and authorizing Veteran's eligibility applications for programs such as, but not limited to, enrollment, eligibility for Veterans Affairs (VA) healthcare benefits, and financial assessment.

Determining entitlement to medical care as well as bill preparation and collection on all billable episodes of inpatient and outpatient care.

Ensuring accurate and complete data collection is essential to proper processing of third-party collection requirements as mandated by law.

Serving as expert benefit representative to Health Administration Service (HAS) Leadership and support the management information components of all health eligibility related programs.

Entering data and information when necessary, but also reviewing of reports, records and statistical computations for accuracy and propriety.

Developing financial assessments to determine the veteran's priority for enrollment in the Veterans Affairs (VA) Healthcare System and their eligibility for income-based benefits.

Counseling veterans and their representatives regarding the outcome of the case development process to ensure that eligibility for Veterans Affairs (VA) benefits and services are thoroughly explained, including assistance of resolution with Internal Revenue Service/Social Security Administration Income Verification Audits.

Adjudicating cases that meet Veterans Affairs (VA) hardship determination criteria for Enrollment of Rejected Veterans / Patients required to pay co-pays for care at the time of initial registrations/ Health Benefit Updates and instructs the veteran on the income/ medical expense information required on the VA Form 10-10HS to determine eligibility.

Performing other related duties as assigned. Work Schedule: Monday through Friday; 8:00am-4:30pm Recruitment & Relocation Incentives: Not authorized Critical Skills Incentive (CSI): Not Approved