Medical Reimbursement Technician

Summary This position is located in the Billing and Insurance Verification Department, under Chief Operating Officer (COO) at the Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Consolidated Patient Account Center (CPAC), in Middleton, WI. The primary purpose of this position is to perform a variety of functions, including medical billing, reimbursable and non-reimbursable collections, and insurance verification, as well as other financial management duties assigned. Learn more about this agency Duties ***THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION*** This position involves a multi-grade career ladder. The major duties listed below represent the full performance level of GS-06. At the GS-05 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-06. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher-level work, and availability of funds. Major duties include but are not limited to the following: Validating claims for billing purposes ensuring eligibility and referring questionable coding for review. Submitting claims to third party health insurance carriers, with knowledge of Medicare coverage benefits. Interpreting third party insurance policies and requirements for billing. Taking responsibility for Medicare reimbursable billing activities. Following instructions about timeliness, objectives, and relative priorities for doing work. Handling conflicting goals, objectives, priorities, timelines, and deadlines. Exhibiting flexibility in adapting to changing demands within specific timelines. Accepting and completing work provided by a standardized control system such as batched work, caseload level, or other defined structure. Using a wide range of office software applications such as Microsoft Access, Excel, and Word. Composing correspondence on a situational basis. Processing billings using ICD-9-MC, CPT/4, and HCPCS codes. Performing other related duties assigned. Work Schedule: Monday - Friday; Full - Time, 8:00am - 4:30pm. Recruitment & Relocation Incentives: May be authorized for highly qualified candidates Critical Skills Incentive (CSI): Not Approved Requirements Conditions of employment You must be a U.S. Citizen to apply for this job To be considered for this position, you must complete all required steps in the process. In addition to the application and questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job. Selective Service Registration is required for males born after 12/31/1959 Physical Requirements: The work may require some physical effort such as periods of standing, walking, or bending. There are no special physical demands. 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) - See "Required Documents" below for details. As a condition of employment for accepting this position, you will be required to serve a 1-year probationary period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider: your performance and conduct; the needs and interests of the agency; whether your continued employment would advance organizational goals of the agency or the Government; and whether your continued employment would advance the efficiency of the Federal service. Upon completion of your probationary, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest. Qualifications TO QUALIFY FOR THIS POSITION AT THE GS-5 GRADE LEVEL, YOU MUST MEET ONE THE FOLLOWING CRITERIA: SPECIALIZED EXPERIENCE: Have at least one (1) full year of specialized experience that equipped you with the particular knowledge, skills, and abilities to perform successfully the duties of the position, and that is typically in or related to the work of this Medical Reimbursement Technician position. To be creditable, specialized experience must have been equivalent to at least the next lower level of Federal service. Examples of qualifying specialized experience include: Verification of patients/customer information, entering data into the patients/customer account and automated databases, communication with internal and external customers, meeting required timelines, and administrative support. NOTE: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week. A full year of work is considered to be 35-40 hours of work per week. ~OR~ SUBSTITUTION OF EDUCATION FOR EXPERIENCE: Have successfully completed four (4) years of education above high school 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.NOTE: Transcripts (unofficial or official) must be submitted with your application materials. Education cannot be credited without documentation.~OR~ COMBINATION OF EXPERIENCE AND EDUCATION: Have an equivalent combination of specialized experience and post high school education as described above that demonstrates your ability to perform the duties of this position.NOTE: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week. A full year of work is considered to be 35-40 hours of work per week. Transcripts (unofficial or official) must be submitted with your application materials. Education cannot be credited without documentation. TO QUALIFY FOR THIS POSITION AT THE GS-6 GRADE LEVEL, YOU MUST MEET THE FOLLOWING CRITERIA: SPECIALIZED EXPERIENCE: Have at least one (1) full year of specialized experience that equipped you with the particular knowledge, skills, and abilities to perform successfully the duties of the position, and that is typically in or related to the work of this Medical Reimbursement Technician position. To be creditable, specialized experience must have been equivalent to at least the next lower level of Federal service. In addition to the examples provided at the GS-05 level, examples of qualifying specialized experience include: Validating claims for billing purposes; Ensuring eligibility and referring questionable coding for review; and Interpreting insurance policies and requirements for billing.NOTE: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week. A full year of work is considered to be 35-40 hours of work per week. 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 IMPORTANT: 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 Physical Requirements: The work may require some physical effort such as, periods of standing, walking, or bending. There are no special physical demands. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments. Receiving Service Credit for 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. 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. The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced Federal competitive service employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit appropriate documentation and be found well-qualified (have a final rating of 80 or more before any Veterans preference points) for this vacancy. Information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/. Expand Hide  additional information Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution. Benefits A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits. Review our benefits Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.