Medical Reimbursement Technician
Responsible for the verification of Veterans' insurance coverage for inpatient and outpatient services; Verifies benefits, policy number, pre-certification requirements, Insurance contact information, and effective dates of coverage; Responsible for all reimbursable billing activities including consideration of professional services and facility services, sharing agreements, Medicare, and pharmacy billing; Ensures that all billable cases are identified and that bills are generated; Obtains information required for tort cases, workman's compensation, OWCP, and personal injury cases; Validates claims for billing purposes insuring eligibility and referring questionable coding for review; Responsible for billing, including humanitarian, tort feasor, workman's compensation and no-fault auto accidents; Applies payments to the appropriate bill or refunds to the applicable party;. Performs follow-up on explanation of benefits received from third-party carriers to maximize revenue and reviews payments to ensure consistency with insurance policy terms. Promotion Potential:
The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met. Selection at a lower grade level does not guarantee promotion to the full performance level. Work Schedule:
8a.m -4:
30 p.m Monday - Friday Telework:
Eligibility determined by supervisor after 1 year in the position, and is at full productivity. Virtual:
This is not a virtual position. Position Description/PD#:
Medical Reimbursement Technician/ PD36018A Relocation/Recruitment Incentives:
Not Authorized Financial Disclosure Report:
Not required To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 03/11/2020. You may qualify based on your experience and/or education as described below:
GS 5 Specialized
Experience:
You must have one year of specialized experience , which equips you with the particular knowledge, skills, and abilities to perform successfully the duties of the Medical Reimbursement Technician, GS-05 position, and that is typically in or related to the work of the position to be filled. To be creditable, this specialized experience must have been equivalent to the grade GS-04 level in Federal service to qualify at the grade GS-05. Examples of specialized experience would typically include, but are not limited to:
Submits claims to third party insurance carriers with the use of Medicare coverage benefits. Interprets third party insurance policies and requirements for billing. Validates claims for billing purposes insuring eligibility and referring questionable coding for review. Follows instructions about timeliness, objectives, and relative priorities for doing work. Applies all federal, state, and VA regulations governing the release of information procedures. Note:
Evidence of specialized experience must be supported by detailed documentation of duties performed in positions held on your resume. You must provide work experience information such as hours per week, salary, and starting/ending dates of employment (month and year format) to establish you have one (1) full year of Specialized Experience at or comparable to the required grade level. OR, GS-05:
Substitution of Education for Experience (TRANSCRIPTS REQUIRED):
Do you possess Four (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. 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. OR, GS-05:
Combination of Education and Experience (TRANSCRIPTS REQUIRED):
Do you possess a combination of successfully completed education and experience to meet the total experience requirements. (i.e. 6 months of specialized experience and 3 years of education above the high school level). NOTE:
Only education beyond the second year can be used in combination with specialized experience to qualify for this grade. You will be rated on the following Competencies for this position:
Customer ServiceDecision MakingManages and Organizes InformationSelf-ManagementTechnical Competence 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 is primarily sedentary with long periods of sitting at a desk, working with computers daily. Some work may require walking in offices and similar areas for meetings. Work may also require walking and standing in conjunction with travel to and attendance at meetings and conferences away from the worksite. The work does not require any special physical effort. 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/.
Estimated Salary: $20 to $28 per hour based on qualifications.
The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met. Selection at a lower grade level does not guarantee promotion to the full performance level. Work Schedule:
8a.m -4:
30 p.m Monday - Friday Telework:
Eligibility determined by supervisor after 1 year in the position, and is at full productivity. Virtual:
This is not a virtual position. Position Description/PD#:
Medical Reimbursement Technician/ PD36018A Relocation/Recruitment Incentives:
Not Authorized Financial Disclosure Report:
Not required To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 03/11/2020. You may qualify based on your experience and/or education as described below:
GS 5 Specialized
Experience:
You must have one year of specialized experience , which equips you with the particular knowledge, skills, and abilities to perform successfully the duties of the Medical Reimbursement Technician, GS-05 position, and that is typically in or related to the work of the position to be filled. To be creditable, this specialized experience must have been equivalent to the grade GS-04 level in Federal service to qualify at the grade GS-05. Examples of specialized experience would typically include, but are not limited to:
Submits claims to third party insurance carriers with the use of Medicare coverage benefits. Interprets third party insurance policies and requirements for billing. Validates claims for billing purposes insuring eligibility and referring questionable coding for review. Follows instructions about timeliness, objectives, and relative priorities for doing work. Applies all federal, state, and VA regulations governing the release of information procedures. Note:
Evidence of specialized experience must be supported by detailed documentation of duties performed in positions held on your resume. You must provide work experience information such as hours per week, salary, and starting/ending dates of employment (month and year format) to establish you have one (1) full year of Specialized Experience at or comparable to the required grade level. OR, GS-05:
Substitution of Education for Experience (TRANSCRIPTS REQUIRED):
Do you possess Four (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. 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. OR, GS-05:
Combination of Education and Experience (TRANSCRIPTS REQUIRED):
Do you possess a combination of successfully completed education and experience to meet the total experience requirements. (i.e. 6 months of specialized experience and 3 years of education above the high school level). NOTE:
Only education beyond the second year can be used in combination with specialized experience to qualify for this grade. You will be rated on the following Competencies for this position:
Customer ServiceDecision MakingManages and Organizes InformationSelf-ManagementTechnical Competence 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 is primarily sedentary with long periods of sitting at a desk, working with computers daily. Some work may require walking in offices and similar areas for meetings. Work may also require walking and standing in conjunction with travel to and attendance at meetings and conferences away from the worksite. The work does not require any special physical effort. 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/.
- Department:
0503 Financial Clerical And Assistance - Salary Range:
$34,916 to $45,393 per year
Estimated Salary: $20 to $28 per hour based on qualifications.
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