Summary The position is located in the Veterans Health Administration (VHA) Office of Finance's, Payment Operations (PO). Through the VHA Chief Financial Officer (CFO), VHA's Office of Finance serves in a mission critical role as the principal financial advisor to the Under Secretary for Health (USH). This vacancy may be filled in Washington, DC or one of the 3 VA payment centers listed Applicants must live within 50 miles of the payment center prior to start date if selected Responsibilities This position functions as a Claims and Service Specialist (CSS) Legal Administrative Specialist. The incumbent performs work in the areas of community care coordination and payment of claims related to care in the community to administer benefits and to resolve concerns from Veterans and non-VA providers. Duties include management of claims and conducting reviews as required by their direct supervisor. The primary purpose of this position is to improve the Veteran and non-VA provider experience with care in the community. The position is expected to perform a variety of support service functions and related work in dispersing information to the public on rights, benefits, privileges, or obligations; explaining pertinent legal provision, regulation, and related administrative practices, and their application to specific cases; and assisting individuals in developing needed evidence and preparing required documents to process claims, or in resolving errors, delays, or other problems in obtain benefits or fulfilling obligations. Performs work to facilitate claims payment and customer service by examining Veteran's medical records, community care authorizations, community payment records and historical tracking of submitted health care claims. Conducts performance reviews to determine the economy, efficiency, and effectiveness of program operations and to determine whether the entity has complied with laws and regulations applicable to the program. 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: Required to work Monday through Friday, TBD upon selection Compressed/Flexible: Available - TBD upon successful completion of orientation Telework: Available after successful completion of a 90-day on-site orientation Remote: This is not a remote position. Virtual: The employee may work at the VA facility or other VA-leased space at an address specified in this announcement that is hiring the employee and is authorized for telework up to 50%, after successful completion of a 90-day on-site orientation. Position Description/PD#: Legal Administrative Specialist/PD13073A and PD13072A 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 Qualifications To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 10/23/2024. 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-7 position you must have served 52 weeks at the GS-05. For a GS-09 position you must have served 52 weeks at the GS-07. 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. GS-07: You may qualify based on your experience and/or education as described below: GS-07 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 include: 1) Claims management including a wide range of vouchers having a variety of complicating factors to include the resolution of various error codes, other health insurance calculations, payment authorization, and batching payment requests that cannot be completed by the automated system. 2) Identifies problems or answers questions about entitlement and services that can or cannot be provided; identifies sources of difficulty in obtaining services; negotiates VA processes on behalf of Veterans. 3) Provides explanation regarding Veteran eligibility and/or entitlement to benefits according to the Veterans Benefit Package and the laws and regulations governing VA authority that authorize payment for care in the community. 4) Investigates complaints, initiates actions, appeals, or changes to rectify the situation, and reports corrective measures taken to parties involved. 5) Identifies the elements of the clinical or administrative practices that contribute to or create an atmosphere for patient customer dissatisfaction and recommends changes that will reduce or eliminate complaints. OR, GS-07 Substitution of Education for Experience (TRANSCRIPTS REQUIRED): Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have 1 full year of graduate level education or superior academic achievement (S.A.A).S.A.A. is based on (1) class standing, (2) grade-point average, or (3) honor society membership.1. Class standing -- Applicants must be in the upper third of the graduating class in the college, university, or major subdivision, such as the College of Liberal Arts or the School of Business Administration, based on completed courses.2. Grade-point average (G.P.A.)-- Applicants must have a grade-point average of:a. 3.0 or higher out of a possible 4.0 ("B" or better) as recorded on their official transcript, or as computed based on 4 years of education, or as computed based on courses completed during the final 2 years of the curriculum; orb. 3.5 or higher out of a possible 4.0 ("B+" or better) based on the average of the required courses completed in the major field or the required courses in the major field completed during the final 2 years of the curriculum. Grade-point averages are to be rounded to one decimal place. For example, 2.95 will round to 3.0 and 2.94 will round to 2.9.3. Election to membership in a national scholastic honor society -- Applicants can be considered eligible based on membership in one of the national scholastic honor societies listed below. These honor societies are listed by the Association of College Honor Societies (external link). Agencies considering eligibility based on any society not included in the following list must ensure that the honor society meets the minimum requirements of the Association of College Honor Societies. Membership in a freshman honor society cannot be used to meet the requirements of this provision. OR; GS-07: Combination of Education and Experience (TRANSCRIPTS REQUIRED): Applicants may also combine education and experience to qualify at this level. You must have an combination of education beyond an Undergraduate degree and specialized experience directly related to the work of the Legal Administrative Specialist position. GS-09: You may qualify based on your experience and/or education as described below: GS-09 Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-07 in the normal line of progression for the occupation in the organization. Examples of specialized experience include: 1) Claims management including a wide range of vouchers having a variety of complicating factors to include the resolution of various error codes, other health insurance calculations, payment authorization, and batching payment requests that cannot be completed by the automated system. 2) Identifies problems or answers questions about entitlement and services that can or cannot be provided; identifies sources of difficulty in obtaining services; negotiates VA processes on behalf of Veterans. 3) Provides explanation regarding Veteran eligibility and/or entitlement to benefits according to the Veterans Benefit Package and the laws and regulations governing VA authority that authorize payment for care in the community. 4) Investigates complaints, initiates actions, appeals, or changes to rectify the situation, and reports corrective measures taken to parties involved. 5) Identifies the elements of the clinical or administrative practices that contribute to or create an atmosphere for patient customer dissatisfaction and recommends changes that will reduce or eliminate complaints. 6) Gathers, analyzes, and prepares information while applying sound judgment when responding to inquiries. 7) Contributes to vendor recovery while completing complex requests in a timely and efficient manner. OR; GS-09: Substitution of Education for Experience (TRANSCRIPTS REQUIRED): A master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related. Such education must demonstrate the knowledge, skills, and abilities necessary to do the work. OR; GS-09: Combination of Education and Experience (TRANSCRIPTS REQUIRED): Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and successfully completed Graduate level education directly related to the work of the Legal Administrative Specialist position. You will be rated on the following Competencies for this position: Customer Service Knowledge Management Organizational Stewardship 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. Physical Requirements: Long periods of sitting in one location are required in completing transactions utilizing a computer with standard office equipment. 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 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 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.