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Claims Assistant - Department of Veterans Affairs - Richmond, VA

Summary

About the Agency

OUR MISSION: To fulfill President Lincoln's promise: "To care for him who shall have borne the battle, and for his widow, and his orphan" - by serving and honoring the men and women who are America's Veterans. How would you like to become a part of a team providing compassionate care to Veterans?

The Department of Veterans Affairs (VA) needs employees who possess the energy, compassion, and commitment to serve those who served our Country. Whatever the job title, every position in VA will give you a chance to make a meaningful and personal contribution to the lives of truly special and deserving people - our Veterans. VA professionals feel good about their careers and their ability to balance work and home life. VA offers generous paid time off and a variety of predictable and flexible scheduling opportunities. Working for VA is one of the most emotionally satisfying and professionally rewarding ways to dedicate the best within you to your Country's service. If you are transitioning from the military or a Veteran already, we invite you to explore the benefits of continuing your career at the VA. The VA is committed to hiring Veterans.

The VA is much more than just another employer. It is an honorable, open and welcoming community of those who care. Gratitude is our motivation and service is our mission.

The VA has adopted Core Values and Characteristics that apply universally across the Department. The five Core Values define "who we are," our culture, and how we care for Veterans, their families and other beneficiaries. The Values are Integrity, Commitment, Advocacy, Respect and Excellence ("I CARE"). America's Veterans need you!

Duties

This position, located within the Richmond VA Medical Center, Virginia, is an active member of the Medical Care Collections Program (MCCF) and Non-Medical Care Collections Fund (Non-MCCF) revenue cycle program working within the scope of the VA for revenue reimbursement. Primary functions include developing comprehensive internal standard operating procedures and detailed tracking systems, building a foundation and objectives for the long-range achievement and organization of the TRICARE, DoD and ChampVA Non-MCCF programs and agreements.

Additional duties include but not limited to:

• Uses revenue and insurance related databases to counsel, monitor and validate all Non-MCCF patient authorizations, claims, referrals, and pre- and post- billing transactions;
• Coordinates and develops all specialty claims, ensuring accurate claims are created and resolved in compliance with current policies, procedures and regulatory laws;
• Analyzes payments and Explanation of Benefits (EOB) received from insurance companies;
• Researches and follows up with unsatisfactory third party response (i.e. claim denials, inadequate payment, and non-response to claim submission in order to ensure maximum patient account reimbursement to the facility;
• Runs weekly Billing Reports to audit claims;
• Initiates correspondence and phone communication to insurance companies and patients as needed, to provide and collect information necessary to process insurance claims;
• Accepts and processes all Release of Information (ROI) and Freedom of Information Act (FOIA) requests and processes them through designated database;
• Trains new and current staff on billing and auditing procedures; and
• Performs all other duties as assigned.

Work Schedule: Full-Time, Compressed and Flexible work schedules available
Recruitment & Relocation Incentives: Not authorized
Financial Disclosure Report: Not Required

Travel Required

• Not Required

Relocation Authorized

• No

Job Requirements

Key Requirements

• Must be a U.S. citizen
• Subject to a background/security investigation
• Designated and/or random drug testing may be required
• Selective Service Registration is required for males born after 12/31/1959
• May be required to serve a probationary period.

Qualifications

To qualify for this position at the GS-7 grade level, you must have the following:
At least one (1) full year of specialized experience equivalent to at least the next lower grade in federal service (GS-6). This experience is close to the work of this position and has given me the particular knowledge, skills, and abilities required to successfully perform the duties of this Claims Assistant position. Specialized experience includes performing clerical and administrative support duties including utilizing accounting concepts as they relate to accounts payable/receivables, collections and auditing procedures; processing insurance claims for reimbursement; utilizing office automation software needed to develop spreadsheets, data tracking, etc.; and interpreting rules and regulations applicable to claims processing. 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.

You will be rated on the following Competencies as part of the assessment questionnaire for this position:

• Accounting Operations
• Communication
• Computer Skills
• Technical Competence
• Technical Credibility

For more information on these qualification standards, please visit the United States Office of Personnel Management's website at http://ift.tt/1dO9mm4.
There is typically no educational substitution at the GS-7 level.
Physical Demands & Work Environment: The work is primarily sedentary, although some slight physical effort may be required. There may be some walking, standing, bending, public speaking, carrying of light items such as papers, books, or small parts, or driving an automobile. The work is performed in an office setting with a computer terminal and software, printer, calculator, and telephone. There is susceptibility to eyestrain from working long hours on the computer. Work is typically performed in an adequately lighted and climate controlled office.

Security Clearance

Other

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