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Summary This position is located at the North-Central Consolidated Patient Account Center, Billing and Insurance Verification Department in Middleton, WI. The Medical Reimbursement Technician performs a broad range of duties to achieve established and expected results for medical billing and reimbursable and non-reimbursable collections. Responsibilities ***THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION*** Validate claims for billing purposes ensuring eligibility and referring questionable coding for review. Submit claims to 3rd party health Insurance Carriers, with knowledge of Medicare coverage benefits. Interprets third party insurance policies and requirements for billing. Take responsibility for Medicare reimbursable billing activities. Follow instructions about timeliness, objectives, and relative priorities for doing work. Handle conflicting goals, objectives, priorities, time-lines, and deadlines. Exhibit flexibility in adapting to changing demands within specific time lines. Accept and completes work provided by a standardized control system such as batched work, caseload level, or other defined structure. Use a wide range of office software applications such as Microsoft Access, Excel, and Word. Compose correspondence on a situational basis. Process billings using ICD-10-MC, CPT/4, and HCPCS codes timely. 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: 8:00am - 4:30pm Compressed/Flexible: Not Authorized Telework: Not Authorized Virtual: This is not a virtual position. Position Description/PD#: Medical Reimbursement Technician/PD36018A and PD36017A Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized 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. 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 dentification 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) Qualifications To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 05/15/2025. Time-In-Grade Requirement GS-06 Only: 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-06 position you must have served 52 weeks at the GS-05. 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. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment. 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-05 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Follows instructions about timeliness, objectives and relative priorities for doing administrative work. Communicates with other staff as necessary to discuss administrative concerns. Reviews and determine the appropriateness of administrative data. OR, GS-05: Substitution of Education for Experience (TRANSCRIPTS REQUIRED): 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 REQUIED): 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. Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-06 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Follows instructions about timeliness, objectives and relative priorities for doing administrative work. Communicates with other staff as necessary to discuss administrative concerns. Reviews and determine the appropriateness of administrative data. Validates claims for billing purposes ensuring eligibility and referring questionable coding for review. Interprets insurance policies and requirements for billing. You will be rated on the following Competencies for this position: Customer Service (Clerical/Technical) Decision Making Manages and Organizes Information Self-Management Technical 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/. Education As a general rule, education is not creditable above GS-05 for most positions covered by this standard; however, graduate education may be credited in those few instances where the graduate education is directly related to the work of the position. A transcript must be submitted with your application if you are basing all or part of your qualifications on education. Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/. Additional Information Receiving Service Credit or Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed. This job opportunity announcement may be used to fill additional vacancies. 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.