Lead Claims Assistant

Summary The Lead Claims Assistant works as part of the Benefits and Enrollment Section of the Business Office within the Iowa City VA Health Care System (ICVAHCS). The incumbent's primary duties are to help Veterans determine eligibility and entitlement for health care services in the VA system by leading the other Claims Clerks in their day to day duties. Responsibilities Major Duties listed but not limited to: Assist the Medical Administration Officer supervise, lead, develop, mentor, and support the other Claims Clerks in the Eligibility & Enrollment office in their daily work. Monitor the quality and quantity of the work expected, deadlines, and priority of work assigned. Assist the Medical Administration Officer by distributing, prioritizing, and balancing the workload among employees in accordance with established work flow of job specialization. Provide assignments indicating, generally, what duties are to be performed and compile data and required information for any needed reports. Provide specific instructions on new or unusual assignments that have clear precedents, understanding the limitations, setting down deadlines, quantities, and assigning priorities. Interviews and counsels Veterans applying for outpatient and inpatient medical care as determined by Public Laws 99-272 and 100-332 and other VA Handbooks, Manuals and /or Directives Assists veterans in gathering information consulting with or using Hospital Inquiry (HINQ) or Veteran Information System (VIS), State Bonus Boards, VA Regional offices, Health Eligibility Center (HEC), county veteran affairs offices, service organizations, and county court houses Assists veterans with completion of the means test (financial assessment) process by answering veteran's questions and utilizing interview techniques to assist them in completing the means test Obtains completed and signed application and means test when applicable prior to medical services being provided Maintains procedural consistency by completing entry of applications and means test information in a timely manner, expediting some due to medical need or as specified by supervisor Advises and assists individuals applying for special programs, i.e. Agent Orange/Nuclear Weapons/Persian Gulf programs/examination, CHAMPVA (Civilian Health and Medical Program of Iowa), Purple Heart, Veterans Choice Act, and other benefits through VA Regional Offices Screens applicants for humanitarian emergencies, possible third party and workmen's compensation cases Performing other duties as assigned. Work Schedule: Monday - Friday: 7:30am- 4:00pm Virtual: This is not a virtual position. Position Description/PD#: Lead Claims Assistant/PD503590 Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Authorized Permanent Change of Station (PCS): Not Authorized PCS Appraised Value Offer (AVO): Not Authorized The VA Midwest Health Care Network advocates for a Whole Health System of care in each of the Medical Centers. This is an approach to healthcare that empowers and equips people to take charge of their health and well-being and live their lives to the fullest. As an employee operating in a Whole Health System of care, you will operate in a model with three core elements, seeking to create a personalized health plan for each Veteran. This is done in the context of healing relationships and healing environments and a connection back to the Veteran's community. This aligns with the Veterans Health Administration (VHA) Mission Statement to Honor America's Veterans by providing exceptional health care that improves their health and well-being. Requirements Conditions of Employment You must be a U.S. Citizen to apply for this job Selective Service Registration is required for males born after 12/31/1959 You may be required to serve a probationary period Subject to background/security investigation Selected applicants will be required to complete an online onboarding process Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP) Participation in the Coronavirus Disease 2019 (COVID-19) vaccination program is a requirement for all Veterans Health Administration Health Care Personnel (HCP) - See "Additional Information" below for details. Qualifications To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 10/16/2024. 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-6 position you must have served 52 weeks at the GS-5. 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. You may qualify based on your experience and/or education as described below: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-5 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Effective communications with individuals, other service-lines, local leadership, etc.; Guiding patients while adhering to various regulations; Assist patients with processing documents; Work with patients to resolve concerns; Interpret documents and notes related to the claims process; and Records maintenance through hard copy or electronic means. You will be rated on the following Competencies for this position: Communications Customer Service (Clerical/Technical) Manages and Organizes Information Problem Solving 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; religions; 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. Note: A full year of work is considered to be 35-40 hours of work per week. 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. Physical Requirements: The work requires minimal physical effort and mainly office work, such as standing, walking, bending, sitting, talking on telephone and typing. Work Environment: The work is normally performed in an office setting. The work area typically is adequately lighted, heated and ventilated. 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/. Education There is no educational substitution at this grade level. Additional Information This job opportunity announcement may be used to fill additional vacancies. Pursuant to VHA Directive 1193.01, VHA health care personnel (HCP) are required to be fully vaccinated against COVID-19 subject to such accommodations as required by law (i.e., medical, religious or pregnancy). VHA HCPs do not include remote workers who only infrequently enter VHA locations. If selected, you will be required to be fully vaccinated against COVID-19 and submit documentation of proof of vaccination before your start date. The agency will provide additional information regarding what information or documentation will be needed and how you can request a legally required accommodation from this requirement using the reasonable accommodation process. If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement. Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act.