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Summary The incumbent serves as a Medical Reimbursement Technician within the Business Office. The incumbent is responsible for performing a broad range of duties to achieve the established Central Office NISN expected results for Medical billings and reimbursable and non-reimbursable collections. The incumbent may also perform insurance verification duties. Responsibilities ***THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION*** This is a multi-grade career ladder position. 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. 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 Work Schedule: 8:00am - 4:30pm, Monday - Friday Compressed/Flexible: May be discussed to meet the needs of the agency. Telework: No Virtual: This is not a virtual position. Position Description/PD#: Medical Reimbursement Technician/PD36017A and PD36018A Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized PCS Appraised Value Offer (AVO): 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 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, 05/22/2025. (GS-06 Only) 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-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. You may qualify based on your experience and/or education as described below: GS-05: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-04 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include: 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: Applicants must have 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. (TRANSCRIPTS REQUIRED). OR, GS-05: Combination of Education and Experience: Applicants must have equivalent combinations of successfully completed education and experience that may be used to meet 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 to qualify for this grade.(TRANSCRIPTS REQUIRED). GS-06 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. 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 If using education to qualify for the GS-05 position, 4 years above high school is required. Education is not applicable for the GS-06 position; 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.