About this role
Job SummaryThis position is aligned under the Veterans Health Administration Office of Finance, and is physically located in Orlando, Florida at the LAKEMONT ANNEX, Florida-Caribbean Consolidated Patient Account Center(CPAC), in either the Billing or Insurance Verification departments. The Medical Reimbursement Technician is responsible for performing a broad range of duties for medical billings and reimbursable and non-reimbursable collections within the Business Office.
QualificationsYou may qualify at the GS-5 level if you fulfill one of the following qualifications: -GS-5 SPECIALIZED EXPERIENCE: One (1) year of specialized experience that equipped you with the particular knowledge, skills, and abilities (KSA's) to perform successfully the duties of the position, and that is typically in or related to the work of this position? To be creditable, this experience must have been equivalent to at least the GS-4 grade level in the Federal service. 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; and reviewing and determining the appropriateness of administrative data. -OR- -GS-5 EDUCATION: Successful completion of 4 years of education above the high school level in any field for 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. (TRANSCRIPTS REQUIRED) -OR- -GS-5 COMBINATION: Equivalent combinations of education and specialized experience (as described above) to meet the requirements at the GS-5 level. Only education in excess of the first 60 semester hours (i.e., beyond the second year) is creditable toward meeting the specialized experience requirement. (TRANSCRIPTS REQUIRED) You may qualify at the GS-6 level if you fulfill the following qualifications: -GS-6 SPECIALIZED EXPERIENCE: One (1) year of specialized experience that equipped you with the particular knowledge, skills, and abilities (KSA's) to perform successfully the duties of the position, and that is typically in or related to the work of this position? To be creditable, this experience must have been equivalent to at least the GS-5 grade level in the Federal service. 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; validating claims for billing purposes ensuring eligibility and referring questionable coding for review; and interpreting insurance policies and requirements for billing. 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/.
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-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. Major duties and responsibilities include: Verifying veterans' insurance coverage for inpatient and outpatient services, entering updated information, and maintaining the database. Documenting pre-admission requirements and identifying patients requiring second opinions. Responsible for all reimbursable billing activities including consideration of professional services and facility services, sharing agreements, Tricare, Champ VA, Medicare, and pharmacy billing. Validating claims for billing purposes ensuring eligibility and referring questionable coding for review; monitoring reports to assure all possible billable cases are processed; and ensuring proper sequencing of diagnostic and procedural codes and assigns modifiers as needed. Responsible for third party collection from insurance companies and for accounts receivable including humanitarian, DoD, Tricare tort feasor, workman's compensation, fugitive felon, ineligible Champ VA, and no-fault auto accidents. Researching and resolving problems and posting payments, adjustments, denial codes, and non-payment collections. Following up on accounts receivable; determining the accuracy of reimbursement received; responding to correspondence and inquiries; expediting and maximizing collections; maintaining records; and making debt adjustment and assigning funds received to the correct account. Verifying the accuracy of payments, resolving problems and discrepancies, and closing out accounts. Responding to questions and inquiries from veterans and insurance companies. Auditing accounts, ensuring payments recovered by insurance carrier are posted in a timely manner to the veterans Category C bills. Performs other duties as assigned. Work Schedule: Monday-Friday 8:00am-4:30pm Recruitment & Relocation Incentives: Not authorized Critical Skills Incentive (CSI): Not approvedRequirementsYou must be a U.S. Citizen to apply for this job To be considered for this position, you must complete all required steps in the process. In addition to the application and questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job. Selective Service Registration is required for males born after 12/31/1959 Physical Requirements: The work required does not inherently include any physical requirements essential for successful job performance that could not otherwise be performed with accommodation or workplace adjustment. A pre-placement physical examination is not required. Subject to background/security investigation Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP) - See "Required Documents" below for details. As a condition of employment for accepting this position, you will be required to serve a 1-year probationary period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider: your performance and conduct; the needs and interests of the agency; whether your continued employment would advance organizational goals of the agency or the Government; and whether your continued employment would advance the efficiency of the Federal service. Upon completion of your probationary, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.