About this role
Job Summary
About the Position
The Contact Representative serves as the Health Benefits Advisor assisting a diverse beneficiary population by providing expert guidance on entitlements, benefits, covered and non-covered procedures, and pre-authorization processes. This is a Direct Hire Authority (DHA) solicitation utilizing the DHA for Certain Personnel of the DoD to recruit and appoint qualified candidates to positions in the competitive service.
Qualifications
Who May Apply: US Citizens In order to qualify, you must meet the education and/or experience requirements described below. 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). You will receive credit for all qualifying experience, including volunteer experience. Your resume must clearly describe your relevant experience; if qualifying based on education, your transcripts will be required as part of your application. Additional information about transcripts is in this document. Specialized Experience: One year of specialized experience which includes any two or more of the following;
- 1) assisting beneficiaries by resolving or correcting discrepancies of existing medical claims,
- 2) providing regulatory healthcare guidance to the patient population on their rights, benefits, privileges, access to care and available eligibilities, or
- 3) counseling beneficiaries on a broad range of available health benefit programs.
This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-07). OR Education: One and a half years of graduate level education in a field which demonstrates the knowledge, skills, and abilities necessary to do the work of the position, such as Business Management, Health Care Administration, etc. OR Combination of
Education and Experience
A combination of education and experience may be used to qualify for this position as long as the computed percentage of the requirements is at least 100%. To compute the percentage of the requirements, divide your total months of
Major Duties
- Incumbent works to resolve claims payment issues and verify beneficiary eligibility.
- Delivers informational briefings to active military units, family support groups, and civilian healthcare providers.
- Collects, enters, and analyzes patient satisfaction/complaint data and generates reports
- Research indirect patient care issues.
- Educate patients and staff on healthcare options, rights, and responsibilities
- Participates in multidisciplinary committees on patient care quality, performance improvement, and compliance with standards.