The primary responsibility of the individual in this position is to support the Health Benefits Unit in researching, determining, and explaining complex health benefits and enrollment questions to both internal and external customers of the VA Ann Arbor Healthcare System. To process enrollment applications and work through multifaceted eligibility requirements that guarantees the accurate and timely assignment of healthcare benefits.
To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 01/30/2026. 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 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. Applicants must be eligible under the VA Interchange Agreement, having served continuously for at least one year in the other merit system under this interchange agreement. For more information regarding the VA Interchange Agreement please visit: https://www.opm.gov/policy-data-oversight/hiring-authorities/competitive-hiring/. - All Title 38 Veterans Canteen Service (VCS) employees must have served in their Excepted Service position for at least 90 days in order to be eligible for a position within the Competitive Service. - Applicants who were previously selected under a Competitive Delegating Examining Unit (DEU) announcement must have served in their position for at least 90 days prior to being eligible for other positions within the Competitive Service. You may qualify based on your experience as described below: Specialized Experience: GS-06: 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. GS-07: You must have one year of specialized experience equivalent to at least the next lower grade GS-06 in the normal line of progression for the occupation in the organization. Examples of specialized experience GS-6 Level: A thorough and comprehensive knowledge of pertinent laws, federal regulations, polices guidelines, VHA directive and procedures that require extensive training. An in-depth knowledge and experience in the field of patient administration (both inpatient and outpatient), including medical records and related fields of medical administration, especially related to any HAS Program. Examples of specialized experience GS-7 Level: Extensive Knowledge of Special Emphasis programs to include OEF/OIF/OND (Operation Enduring Freedom/Iraqi Freedom/New Dawn), Caregiver Program, Fugitive Felon Program (FFP), Affordable Care Act, Clay Hunt Act, Camp Lejeune, Agent Orange, Southwest Asia, Burn Pit Registry, Dental Eligibility, Ionized Radiation, Shipboard Hazard and Defense (Project SHAD). Also, requires limited knowledge of Traveling Veterans Coordination (TVC), Indian Health Services (INS), CHAMPVA, Decedent Affairs and Veterans Community Care and HUD-VASH. You will be rated on the following Competencies for this position: Analytical Reasoning Attention to Detail Computer Skills Customer Service Oral Communication 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: This is primarily a sedentary position, but the work requires some walking, bending, stooping and carrying of light objects such as manuals, documents, etc. Concentration and sustained performance under prolonged stress is required because of the time factors involved in completion of work assignments within deadlines. 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/.
Health Benefits Contact Representative Serves as the subject-matter expert and is responsible for applying an extensive body of rules and regulations relative to Veterans Eligibility for VA healthcare benefits, interpretation of relevant laws, VHA guidelines and regulations, and other federal agency policies is required to ensure that timely and appropriate measures are taken throughout data collection and data entry processes. Processing requests to update veterans personal, eligibility and enrollment information, entering demographic, insurance, and income information. Serves as a base for determining entitlement to medical care as well as bill preparation and collection on all billable episodes of inpatient and outpatient care. Accurate and complete data collection is essential to proper processing of third-party collection requirements as mandated by law. Serve as expert benefit representative to HAS Leadership and support the management information components of all health eligibility related programs. Provides administrative support and collaborates with inpatient staffing personnel such as Physicians, Physician's Assistants, Nurses, Advanced Registered Nurse Practitioners, Dietitians, Social Workers, and other administrative and professional staff throughout AAVAMC area transitioning patients identified as ineligible for VA patient care. Accurately generates patient data cards for veterans through the Identity Management Toolkit for proofing identity and the Veterans Health Identification Card (VHIC) System. Monitors enrolled patient data base information on a regular basis (at a minimum, annually) to perform updates to health insurance data, income assessments for the Means Test and Pharmacy Co-pay Exemption programs as mandated by law. Correspondence Prepares written correspondence for a broad spectrum of complex inquiries from intel and external customers by independently recognizing issues, topics, or problems. Prepares, composes, and reviews correspondence prepared for the purpose of obtaining or supplying information. Resolves conflicting or inconsistent information by dealing with various VA offices, sorting out errors and researching past transactions, cases or events. Consult Coordination/New Enrollment Appointment Request (NEAR) List Managing the NEAR list and electronic wait list to verify and validate accuracy and resolve issues; providing input during team meetings and to assist in resolving problems having to do with enrollment issues, or panel assignments. Generates and monitors enrolled patient data base information for accurate health insurance data Customer Service Provide exceptional customer service by exceeding the customer's expectations Actively listen to customers with respect and concern; the incumbent will pay attention to the details of the customer's needs and help the customer arrive at a satisfactory solution to the problem Communicates and interacts with patients in a manner which is appropriate to cognitive, emotional, and chronological maturation needs of the adult and/or geriatric patient. Perform all other related duties as assigned. 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: Monday - Friday 8:00am to 4:30pm Compressed/Flexible: Not Authorized Virtual: This is not a virtual position. Position Description/PD#: Contact Representative/PD92689A and PD92690-A Financial Disclosure Report: Not required