These positions are located within the Business Office at the Dwight D. Eisenhower Veterans Affairs Medical Center located in Leavenworth, Kansas. The position is responsible for performing a broad range of duties to achieve the established expected results for Medical billings and reimbursable and non-reimbursable collections.
TO QUALIFY FOR THIS POSITION AT THE GS-5 LEVEL YOU MUST MEET THE FOLLOWING CRITERIA: SPECIALIZED EXPERIENCE: Have at least one (1) full year of specialized experience equivalent to at least the next lower grade level (GS-4) in the Federal Service that has given you the knowledge, skills and abilities required to successfully perform the duties of a Medical Reimbursement Technician. Specialized experience includes following instructions about timeliness, objectives, and relative priorities for doing administrative work; communicating with other staff as necessary to discuss administrative concerns; reviewing and determining the appropriateness of administrative data. -OR- EDUCATION: Have successfully completed four (4) years of education above the high school level in any field which high school graduation or the equivalent is the normal prerequisite. This education 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. NOTE: If you select this option, you must submit a copy of your transcript with your application. Education cannot be credited without documentation. -OR- COMBINATION: Have equivalent combinations of successfully completed post-high school education (beyond the second year) and specialized experience, as described above, which meet the total experience requirements for this grade level. This education must have been obtained in an accredited business, secretarial or technical school, junior college, college or university. NOTE: If you select this option, you must submit a copy of your transcript with your application. Education cannot be credited without documentation. TO QUALIFY FOR THIS POSITION AT THE GS-6 LEVEL YOU MUST MEET THE FOLLOWING CRITERIA: SPECIALIZED EXPERIENCE: Possess at least one (1) full year of specialized experience equivalent to at least the next lower grade level (GS-05) in the Federal Service that has given you the knowledge, skills and abilities required to successfully perform the duties of a Medical Reimbursement Technician. Specialized experience includes following instructions about timeliness, objectives, and relative priorities for doing administrative work; communicating with other staff as necessary to discuss administrative concerns; reviewing and determining the appropriateness of administrative data; verifying claims for billing purposes ensuring eligibility and referring questionable coding for review; and interpreting insurance policies and requirements for billing. NOTE: Applicants wishing to receive credit for such experience must clearly indicate the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. You will be rated on the following Competencies as part of the assessment questionnaire for this position: Customer Service (Clerical/Technical) Decision Making Manages and Organizes Information Self-Management Technical Competence IMPORTANT: A full year of work is considered to be 35-40 hours of work per week. All experience listed on your resume must include the month and year start/end dates. 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. 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). 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. Physical Requirements: The work may require some physical effort such as, periods of standing, walking, or bending. There are no special physical demands. 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/.
***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-6. At the GS-5 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-6. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher level work, and availability of funds. Duties may include, but are not limited to the following: Performs verification of veterans' insurance coverage for inpatient and outpatient services. Enters updated information and maintains the database. Verifies benefits, policy number, pre-certification requirements, insurance company contact Information, and effective dates of coverage. Documents pre-admission requirements and identifies patients requiring second opinions. Assists with the pre-certification process, generating monthly reports, and reviewing and explaining insurance coverage with veterans. Responsible for all reimbursable billing activities including consideration of professional services and facility services, sharing agreements, Tricare. Champ VA, Medicare, and pharmacy billing. Ensures that all billable cases are identified and that bills are generated. Validates claims for billing purposes ensuring eligibility and referring questionable coding for review. Monitors reports to ensure all possible billable cases are processed. Ensures proper sequencing of diagnostic and procedural codes and assigns modifiers as needed. Tracks, reviews, and corrects denials. Responds to veterans' questions and explains eligibility requirements, insurance provisions, and billing and payment procedures. Responsible for third party collection from insurance companies and for accounts receivable. Performs other related duties as assigned. Work Schedule: Monday-Friday, 8:00am-4:30pm Recruitment & Relocation Incentives: Not authorized Critical Skills Incentive (CSI): Not Approved