Health Benefits Assistant

Full Job Description

This position is located in the Business Office, Eligibility/Intake Section. The purpose of the position is to serve as a Health Benefits Advisor, to the Business Office.

The incumbent 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, applicants must meet all requirements by the closing date of this announcement, 04/01/2026.

Time-In-Grade Requirement: Advancement to positions up to GS-05 Candidates may be advanced without time restriction to positions up to GS-05 if the position to be filled is no more than two grades above the lowest grade the employee held within the preceding 52 weeks under his or her latest non temporary competitive appointment.

The grade may have been in any occupation, but must have been held in the Federal service. If applicable an SF-50 must be submitted with your application materials.

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-04 in the normal line of progression for the occupation in the organization.

Examples of specialized experience would typically include, but are not limited to: Enter and update data such as demographics, insurance, and income into computerized databases; Prepare correspondence to address complex inquiries from internal and external customers; Monitor and update databases to maintain accurate health enrollment records; Provide guidance and clarification on enrollment and eligibility issues.

OR, Education: Applicants may substitute education for the required experience.

To qualify based on education for this grade level you must have successfully completed four (4) years of education above the high school level.

NOTE: This education can be in any field for which high school graduation or the equivalent is the normal prerequisite and must have been obtained in an accredited business, secretarial or technical school, junior college, college or university.

One year of full-time academic study is defined as 30 semester hours, 45 quarter hours, or the equivalent in a college or university, or at least 20 hours of classroom instruction per week for approximately 36 weeks in a business, secretarial, or technical school.

OR, Combination: Applicants may also combine education and experience to qualify at this level.

You must have an combination of specialized experience and education (beyond the second year) and specialized experience as described above, which meet the total experience requirements for this grade level.

NOTE: Transcripts (unofficial or official) must be submitted with your application materials. Education cannot be credited without documentation. Experience must be clearly indicated in your resume.

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:

Eligibility and Enrollment 25%: Performs technical activities involved with screening, processing, and assisting veterans, non­veterans, and beneficiaries seeking multiple medical treatments.

Interprets and fully understands all eligibility to make initial determinations whether Veterans or non-Veterans meet legal/contractual requirements for medical care.

Familiar with government documents, such as DD-214s, to help make such determinations where no documentation exists, he/she is skilled and knowledgeable on how and where to initiate a timely search to obtain necessary documentation.

Advises patients on National VA Enrollment, the Uniform Benefits Package, and non-medical benefits.

Obtains all key information needed, including but not limited to complete and accurate demographic information, health insurance information, worker's compensation information, etc.

Initiates and completes all administrative processing of requests and forms, including but not limited to, applications for care, financial statements, means tests, copay tests, etc.

Accurately generates patient data cards for Veteran applying for care using the Veterans Health Identification Card (VHIC) system. Provides on-the-job training to new Health Benefits Advisors.

Help develop functional processes and Standard Operating Procedures (SOPs). Customer Service, Teamwork, Communication 25%: Provide exceptional customer service by exceeding the customer's expectations.

Incumbent interacts with a wide range of individuals, with varying degrees of understanding. Counsels Veterans and/or their representatives when adverse decisions are made.

Compiles data and information necessary to respond to Congressional, patient, and attorney requests.

Responds to inquiries on inpatient/outpatient programs at the local site, as well as at other facilities within the Network area.

Handles suicide calls received from Veterans in an appropriate and sensitive manner following national, VISN and facility protocol.

Signals co-worker to obtain clinical provider, maintains veteran on-line interacting through approved guidelines until provider arrives to take contact.

Program Support 20%: Investigates discrepancies and affects resolution of problems through collaborative measures between our facility, other VA medical centers and Austin as necessary.

Participates in quality improvement, team planning, strategy development, problem solving, and data validation activities which include analysis of information.

Confidentiality and Security 15%: Regular and recurring contact with personnel external to the agency for the obtainment of services, sharing or information and authorization, clarification or denial of payment.

Determining Beneficiary Travel Eligibility 10%: Responsible for gathering, entering and updating demographic, employment, insurance and income (means test) information into VISTA.

Provides claims development for all types of eligibility requests for inpatient and outpatient treatment as well as other special programs (i.e.

Prosthetics, Dental Services, Nursing Home Care, Humanitarian, CHAMPVA, DoD Sharing Agreement activities, and non-DoD sharing agreements and/or contracts.

Assists in orienting and educating clinical and administrative staff, in VA regulations, policies, and procedures on VA National Enrollment and the Uniform Benefits Package, as well as Consolidated Patient Account Center (CPAC), encounter forms and processing of workload.

Clinic Scheduling 5%: Interpret and communicate requirements of VHA Scheduling Directives and complete accurate scheduling responsibilities to include PACT.

Making and checkout of appointments, monitoring and correction of encounter data, answering telephones, etc following all established procedures and protocols. Perform other duties as assigned.

Work Schedule: Monday-Friday 7:30am-4:00pm Virtual: This is not a virtual position.

Position Description/PD#: Health Benefits Assistant/PD30474A Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized The VA Midwest Health Care Network advocates for a Whole Health System of care in each of the Medical Centers.

This is an approach to healthcare that empowers and equips people to take charge of their health and well-being and live their lives to the fullest.

As an employee operating in a Whole Health System of care, you will operate in a model with three core elements, seeking to create a personalized health plan for each Veteran.

This is done in the context of healing relationships and healing environments and a connection back to the Veteran's community.

This aligns with the Veterans Health Administration (VHA) Mission Statement to Honor America's Veterans by providing exceptional health care that improves their health and well-being.