The purpose of the position is to notify Veterans or their representatives of the results of first party copayment reviews. The incumbent will respond to questions and resolve issues pertaining to first party and third-party practices particularly regarding medication charges. The incumbent will also provide eligibility and benefits information; resolve issues concerning pharmacy billing activities and other related services to Veterans, their representatives, the public, and VA employees.
To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 12/16/2025. 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-07 position you must have served 52 weeks at the GS-06. 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 as described below: 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 would typically include, but are not limited to: 1) Receiving and responding to telephone calls/inquiries. 2) Interacting effectively with callers to determine the primary purpose of calls. 3) Researching and resolving caller inquiries. 4) Responding to questions regarding complex First Party billing issues. 5) Utilizing various automated systems/databases. 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/.
Major duties include, but are not limited to: Places outbound telephone calls and answers inbound telephone calls concerning billing inquiries, responds to questions and concerns, and clarifies billing determinations made by the pharmacy technician review team. Explains VA standards on secondary/adjunct conditions and the process of adjudication for additional or worsening SC conditions as well as dispute procedures. Responds to questions and concerns involving complex billing issues. Places and/or receives telephone calls and provides information about VA and related non-VA benefits available to Veterans and their dependents and beneficiaries. Calls involve a broad range of topics and include first party and third-party billing and debt collection, preregistration, Veteran record updates, Veterans' benefits, eligibility requirements, and credit card payments. Provides information concerning how to complete annual income means/copay tests and their importance in the determination of pharmacy prescription copayment exemptions. Reviews master record information contained within the Veterans Health Information Systems & Technology Architecture (VistA) system, Veterans Health Administration Enrollment System (VES), and Electronic Health Record (EHR). Explains in detail the process of filing a claim for benefits, eligibility requirements, repayment plans, and waivers, and advises what forms, evidence, and documentation must be submitted, along with other relevant information needed for each action. Prepares well-defined case notes when additional actions or referrals are indicated, available resources are insufficient to answer the caller's inquiry, and/or additional research is required. Determines the most appropriate action or identifies alternatives in resolving issue(s) through in-depth research, interpretation and analysis of master record information contained within VistA, Computerized Patient Record System (CPRS), EHR, Veteran Patient Statement (VPS), VES, Consolidated Mail Outpatient Pharmacy (CMOP), Customer Relationship Management (CRM) systems and other applicable resources and guidelines during telephone interactions. Work Schedule: Full-time, 40 hours per week, Monday through Friday, 8-hour shift between 7:00 am - 4:30 pm. Official tour of duty will be selected based on business needs. Remote: This position is not authorized for Remote work. Telework: This position may be authorized for Telework. Telework eligibility will be discussed during the interview process. (Ad hoc only) Virtual: This position is not authorized for Virtual work. Definition of Virtual work: Employee works outside of original hiring duty station at VA-owned or leased space. Return to Office (RTO): RTO exemptions will be considered and a determination will be made as part of the selection and onboarding process. Position Description/PD#: Contact Representative/PD00725A Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Authorized Permanent Change of Station (PCS): Not Authorized