The primary function of this position is to service as an Enrollment and Eligibility Specialist for the Patient Administration Section (PAS). The AMSA determines eligibility for VA healthcare benefits which requires an extensive knowledge of VA laws, directives, policies, and procedures. The AMSA will be responsible to ensure accurate, timely and consistent information is entered in the appropriate database.
Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. Basic Requirements: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. Basic Requirements: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. Experience and Education: Experience. 12 months experience of clerical, office, [customer service], or other [administrative] work that indicates the ability to acquire the particular knowledge and skills needed to perform the duties of the position OR, Education. One year above high school; OR, Experience/Education Combination. Equivalent combination of experience and education are qualifying for entry level for which both education and experience are acceptable Certification: None required. Foreign Education: To be creditable, education completed outside the U.S. must have been submitted to a private organization that specializes in the interpretation of foreign educational credentials and such education must have been deemed at least equivalent to that gained in conventional U.S. programs. Grade Determinations: Advanced Medical Support Assistant GS-6 Grade Level: Experience: One year of experience equivalent to the [GS-5] grade level. Experience is defined as experience that includes, but is not limited to: scheduling, canceling, re-scheduling patient's appointments and/or consults; entering no-show information; monitoring the electronic wait list; preparing for clinic visits; monitoring both inpatient and outpatient appointments for areas of responsibility; ensuring encounter forms are completed in order to obtain appropriate workload credit; verifying and updating demographics and insurance information; processing all emergency and non-emergency transfers to other VA facilities or private hospitals; performing basic eligibility, co-pays and pre-authorization requirements for specific coverage (i.e., TRICARE, sharing agreements, etc.). Candidates must also be able to demonstrate the following Knowledge, skills, and abilities for the GS-0679-6 level to qualify for this position: Ability to collaborate and communicate with a wide range of medical clinicians across multiple disciplines (e.g. medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical pharmacists, and nursing staff) to accomplish team goal setting to ensure medical care to patients is met. Ability to independently set priorities and organize work to meet deadlines, ensuring compliance with established processes, policies, and regulations. Ability to communicate tactfully and effectively, electronically, by phone, in person, and in writing, with internal and external customers. This may include preparing reports in various formats and presenting data to various organizational levels, as well as resolving patient concerns. Advanced knowledge of the technical health care process (including, but not limited to, scheduling across interdisciplinary coordinated care delivery and/or care in the community models and patient health care portals) as it relates to access to care. Advanced knowledge of policies and procedures associated with interdisciplinary coordinated care delivery and/or care in the community operational activities that affect patient flow, and patient support care administrative functions to include, but not limited to appointment cycles, outside patient referrals, follow-up care, overbooking, provider availability, etc. Advanced knowledge of medical terminology and abbreviations May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation (only applicable to current VHA employees who are in this occupation and meet the criteria). Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. The full performance level of this vacancy is a GS 6. The actual grade at which an applicant may be selected for this vacancy is a GS 06. Physical Requirements: VA Directive and Handbook 5019. Work is partially sedentary, with frequent walking, standing, bending. carrying of light items such as papers and books, or small parts. Some slight physical effort may be required. Incumbent may be susceptible to eyestrain from working long hours on the computer.
The MSA will be assigned work and/or receive training with the objective of acquiring the qualifications needed to successfully facilitate all administrative aspects of the enrollment process, health eligibility determinations and related aspects of health benefits administration as well successfully performing a wide range of administrative functions in support of both administrative and clinical service lines. MSAs must enter all information into the data base for determination of the eligibility status for healthcare: Patient Demographic Data Patient Data Emergency Contact Data Employment Data Insurance Data Military Service Data Eligibility Status Data Family Demographic Data & Income Screen Data Ineligible/Missing Data Eligibility Verification Data MSAs will also assure that all new veterans to the system are registered within 5 business days of receipt of their application. All new eligible applicants will be offered an opportunity to schedule a new patient appointment with the appropriate clinic in adherence to local and national guidelines and policies. MSAs will be required to perform their primary role and related aspects of health benefits administration in direct support of Emergency Department operations such as enrollment & eligibility, registration, pre-registrations, decedent affairs, admissions & inpatient movements and all aspects of scheduling (including the checking in of scheduled and unscheduled appointments). MSAs will perform office various office automation duties such as submitting work order requests, facilitating various methods of communications (i.e. phone lines, faxes, emails etc ... ). MSAs will also coordinate facility transfers both internal and external. The MSAs is responsible for accurate, new patient appointment management. This includes updating and verifying demographics information, scheduling appointments, collecting insurance information, and notifying the patient of his/her scheduled appointment. He/she must use each interaction with the patient to validate and update patient demographic information, either in person during check-in or over the phone, to decrease the incidence of returned mail due to incorrect addresses and inability to contact patient by phone due to incorrect number. In addition, MSAs on a daily basis will verify and update as necessary the patient demographic information of all new inpatients. Explains the VA's mandate to collect insurance information to veterans, their families, and other eligible patients. He/she collects, scans, and updates health insurance information serving a major role in the revenue process. The MSAs contribute to the revenue collection process by identifying patients with third party insurance. Promotes veteran registration for and utilization of MyHealtheVet. MSAs may also be required to train other MSAs on the insurance capture buffer and all other aspects of their position. When records are received, the MSAS will be responsible for ensuring that all necessary health/administrative information are integrated into the Computerized Patient Record System (CPRS) by sending the documents utilizing established procedures to the scanning unit of the Health Information Management Section (HIMS). MSAs must be able to interpret and communicate requirements of VHA Scheduling Directives and complete accurate scheduling responsibilities and assist in training other MSAs as follows: a. Schedule appointments in a timely manner. All appointments will be made with the patient's input. b. Notifies his/her supervisor when clinic access is less than desirable or if an individual patient cannot be scheduled within mandated clinic timeframes. The MSA must have a solid knowledge of multiple electronic systems and current computer technology regarding imaging applications, VISTA application, CPRS, Microsoft Office applications, and all other applicable programs/soft and equipment. MSAs must also have solid knowledge and have the ability to use several types of office equipment to include fax machines, multi-line phone system, printers and copy machines. Work Schedule: Monday - Friday, 8:00am - 4:30pm Telework: Not available Virtual: This is not a virtual position. Functional Statement #: 000000 Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized