Program Specialist

Full Job Description

This position is located within the Community Care service of the Washington, DC, VA Medical Center. It is a highly complex multi-divisional tertiary care, extended care, & teaching medical center.

Community Care is a comprehensive program responsible for the administrative and daily operational management of non-VA authorized and unauthorized medical care.

Also performs important financial & program oversight, cost estimation, budget formulation, payment audits, claims, and payment processing.

To qualify for this position, applicants must meet all requirements by the closing date of this announcement 03/23/2026.

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-07 position, you must have served 52 weeks at the GS-05. For a GS-09 position, you must have served 52 weeks at the GS-07.

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: GS-07 minimum qualifications: Specialized Experience: One (1) full year of specialized experience equivalent to the GS-05 in the Federal Service, that is directly related to the work of the position and has equipped me with the particular knowledge, skills, and abilities to successfully perform the duties as a Program Specialist.

Specialized experience includes administrative daily operational management of non-VA authorized and unauthorized medical care, performing important financial and program oversight duties with respect to fund control point management, cost estimations for Community Care, budget formulation, payment audits, coordination with VISN and Payment Operations Management (POM) on budget, claims, and payment, and coordination of the State Home.

OR, Education: One (1) full year of graduate-level education OR superior academic achievement.

Education at the graduate level must be obtained in an accredited college or university and must demonstrate the knowledge, skills, and abilities necessary to do the work of this position.

Superior Academic Achievement (SAA): SAA at the baccalaureate level in the coursework detailed above is fully qualifying.

Applicants who wish to apply under this provision must submit proof from their educational institution that they meet one of the criteria listed below.

To qualify for SAA, applicants must have completed all the requirements for a bachelor's degree in a curriculum that is qualifying for the position to be filled and meet one of the following: Rank in the upper one-third of your class in the college, university, or major subdivision.

A grade-point average of "B" (a GPA of 2.95 or higher out of a possible 4.0) for all completed undergraduate courses, or those completed in the last two years of undergraduate study.

A grade point average of "B+" (a GPA of 3.45 or higher out of a possible 4.0) for all courses in your major field of study, or those courses in your major completed in the last two years of undergraduate study.

Membership in a national honor society (other than freshman honor societies) recognized by the Association of College Honor Societies.

For a list of recognized honor societies, please visit http://www.achsnatl.org/quick_link.asp. For more information regarding SAA, please visit http://www.opm.gov/qua1ifications/SEC-ll/s2- e5.asp#e4f.

OR, Combination: An equivalent combination of successfully completed graduate-level education and specialized experience, as described above, to meet the total requirements.

The education portion must include graduate courses that demonstrate the knowledge, skills, and abilities necessary to do the work of this position.

Only education beyond a bachelor's degree may be used to qualify applicants for the GS-07 level. This education must have been obtained in an accredited college or university.

GS-09 minimum qualifications: Specialized Experience: One (1) full year of specialized experience equivalent to at least the next lower grade level (GS-07) in the Federal Service, that is directly related to the work of the position and has equipped me with the particular knowledge, skills, and abilities to successfully perform the duties as a Program Specialist.

Specialized experience includes administrative daily operational management of non-VA authorized and unauthorized medical care, performing important financial and program oversight duties with respect to fund control point management, cost estimations for Community Care, budget formulation, payment audits, coordination with VISN and Payment Operations Management (POM) on budget, claims, and payment, and coordination of the State Home.

OR Education: Successfully completed a master's or equivalent graduate degree OR 2 full years of progressively higher-level graduate education leading to such a degree OR LL.B.

or J.D., if related, in a related field that demonstrates the knowledge, skills, and abilities necessary to do the work of this position.

OR Combination: An equivalent combination of successfully completed graduate-level education (in excess of the first year or 18 semester hours) and specialized experience, as described above, to meet the total requirements.

The education portion must include graduate courses that demonstrate the knowledge, skills, and abilities necessary to do the work of this position.

Physical Requirements & Work Environment: The work involved is primarily sedentary in nature.

Some walking, standing, bending, and carrying of lightweight items are involved in the hand delivery and pickup of documents and files.

Mental concentration and sustained performance under prolonged stress are required due to the complexity and time-sensitive nature of work. Work is performed in an office setting.

The employee may occasionally be exposed to communicable diseases and to patients who are mentally or emotionally/psychologically disturbed.

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 a developmental position in the Community Care service at the Washington, DC, VA Medical Center that forms part of a career ladder leading to the full performance level of Program Specialist, GS-0301-09.

Promotion Potential: The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met.

Selection at a lower grade level does not guarantee promotion to the full performance level.

MAJOR DUTIES AND RESPONSIBILITIES Responsible for all tasks involved in managing obligation fund control points and ensuring all activities are recorded in a timely, accurately, and balances are reconciled.

Reviews and analyzes community care authorizations and payments within several software portals, including but not limited to FBCS, FMS, Vista, DOMA, VSSC, Carepoint, and SharePoint.

This will include analysis of DOD Exception and Payment Reviews. Assures the development of data and long-term budget formulation.

Gathers and analyzes financial data concerning the current and future state of program operations, including project costs based on current trends and review of historical data.

Forecasts shortfalls/excesses within the program and proposes actions to accommodate those changes. Projects costs, analyzes workload, and trends for possible adjustment.

Performs audits of payments made, ensuring accuracy; provides tracking to confirm corrections are made, and bills of collection are issued when appropriate.

Responsible for establishing and updating, at the Austin Automation Center, vendor information (process known as vendorizing) to include social and demographic data, medical specialty code, and tax identification numbers for all NVCC/Fee programs (non-VA hospitalization, outpatient medical, dental, dialysis, and pharmacy).

Exercises initiative and resourcefulness in researching and implementing new methods of planning for and estimating budgetary needs.

Assist in management on all aspects of the interpretation and application of agency guidelines for the budget execution process to the program.

Exercises tact, discretion, and judgment in making budgetary commitments within the program. Researches claims and payments questions from community providers and Veterans.

Analyzes authorizations and claims issues to provide guidance to Community Care staff, Veterans, and community providers.

Serves as service level subject matter expert on billing, claims, and payment for education and training of Community Care staff.

Incumbent serves as a reasonable layperson in the review of medical records for the determination of medical and administrative entitlement under the Millennium bill.

Coordinates the State Home program, a critical, highly visible program that includes contracts for our 560 veterans living in community nursing homes.

Tracks veteran movement throughout community nursing homes and assisted living.

Responsible for determining the appropriate billing rate based on the veteran's eligibility and for processing State Home applications within 10 calendar days.

Serve as a subject matter expert to answer veteran and provider questions regarding billing and payment, including by phone, by secure message, by email, and in response to PATS-R and EV complaints.

Perform other duties as assigned. Work Schedule: 8:00 am - 4:30 pm, Monday - Friday Virtual: This is not a virtual position.

Position Description/PD#: Program Specialist/PD21033-O and PD21034-O Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized