Lead Medical Support Assistant (Health Benefits)
What you'd do
The Lead Advanced Medical Support Assistant for Health Benefits is located under the Patient Support Unit and Health Benefit Section aligned under Health Administration Service. The incumbent is primarily responsible for leading staff, under the supervision of the Supervisor of Health Benefit Administration, in the intake and administrative processes for Veterans and beneficiaries applying for eligibility within the Veterans Health Administration (VHA).
Major duties
The Lead Advanced Medical Support Assistant for Health Benefits is primarily responsible for leading staff, under the supervision of the Supervisor of Health Benefit Administration, in the intake and administrative processes for Veterans and beneficiaries applying for eligibility within the Veterans Health Administration (VHA). Duties include but are not limited to: Interviews and registers applicants in VES software to determine eligibility and legal entitlement of applicants for health care, including assignment into the appropriate enrollment priority group. Verifies eligibility using various methods, including; income assessments, military discharge documents, Veteran information solutions (VIS), and other means such as communications with a VA Regional Office. Advises and counsels Veterans and their beneficiaries or representatives of financial obligations, co-pay requirements, and their rights to appeal Resolves complex eligibility, co-pay, and insurance questions that arise Assists AMSAs using VHA regulations, standard operating procedures, and various information systems in making eligibility determinations that may be more intricate due to special factors that may be involved in the Veteran's service record. gathering, entering, and updating demographic, employment, insurance, and income verification into the enrollment system (VES), Veteran Integrated Software Technology (VistA), and other related programs. monitor or be assigned to process electronic health care applications and/or determine eligibility and schedule Primary Care appointments for Veterans on initial enrollment Processes claims for hardship determinations, catastrophic disability, beneficiary travel deductible waivers, and appointment/inpatient stay copay waivers. Routinely provides administrative processing in emergency situations, such as patients being directly admitted to the Emergency Department with immediate needs. Assists the supervisor in leading change initiatives throughout the Eligibility and Enrollment Section. Work Schedule: Monday - Friday, 8:00am - 4:30pm Telework: Not Available Virtual: This is not a virtual position. Functional Statement #: 34365F Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized
What you need to qualify
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: Citizenship. Be a citizen of the United States (U.S.). Non-citizens may be appointed when it is not possible to recruit qualified citizens according to 38 U.S.C. § 7407(a). Experience. No experience required. Education. High school diploma, General Education Development equivalency certificate, or proficiency certificate from a State or territorial-level Board or Department of Education. Licensure/Certification/Registration. None. Foreign Education. To be creditable, education completed outside the U.S. must be deemed at least equivalent to that gained in a conventional U.S. program by a private organization specializing in the interpretation of foreign educational credentials. Physical Requirements. See VA Directive and Handbook 5019, Employee Occupational Health Service for requirements. English Language Proficiency. Candidates must be proficient in spoken and written English in accordance with 38 U.S.C. § 7403(f). 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). Grade Determinations: Lead Medical Support Assistant, GS-7. To qualify at this level, candidates must have one year of experience equivalent to the GS-6 grade level. Examples of credible experience at this level include, but are not limited to: Utilizes numerous advanced patient systems in support of multiple clinics involved in an interdisciplinary coordinated care delivery model; Coordinates with patient care team to review clinic appointment availability to ensure the clinic schedules are closely monitored to effectively support the needs of the clinics and makes necessary adjustments, maintains effective and efficient communication with the patient and various care providers; processes incoming patient secure messaging through online healthcare portals and coordinates with care team as appropriate; participates in team huddles and team meetings to manage, plan, problem solve, and follow-up with patient care by sharing information and collaborating with the interdisciplinary team; setting priorities and deadlines, adjusting the flow and sequencing of the work to meet team and patient needs; identifies incomplete encounters and communicates findings to providers; as needed; assists the team to reinforce the plan of care and self-help solutions; enters appropriate information into the electronic record; monitors pre-appointment information and/or requirements to assure readiness for patient visit/procedure; manages patient systems to verify and validate accuracy and resolve issues; evaluates patient information and clinic schedule lists to determine whether the patient requires an immediate appointment; informs team members about shared patients. AND In addition to the experience above, the candidate must demonstrate the following knowledge, skills, and abilities (KSAs): Advanced knowledge of medical terminology and a wide range of clinical flow processes relating to access to care across multiple clinics, specialties, and/or community. Skill in communicating with individuals to obtain the desired effect and coordinating with a variety of interdisciplinary care team staff. Ability to utilize numerous advanced patient systems in support of multiple clinics in an interdisciplinary setting. Ability to organize work, set priorities, and delegate tasks/responsibilities in order to meet deadlines. Ability to provide staff development and training. Ability to manage staffing requirements, manage workflow priorities, and adjust the flow of work to meet team and patient needs. This includes the ability to follow-up on pending issues and demonstrate an understanding of the impact of incomplete work across multiple clinics. Note: You must provide detailed information of your experience performed. Information such as "I was a Medical Support Assistant" is insufficient to determine your qualifications. Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hour worked per week. Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. The full performance level of this vacancy is GS-07. The actual grade at which an applicant may be selected for this vacancy is GS-07. Physical Requirements: Operate a computer terminal and be able to manage multiple activities at one time. Work is generally sedentary; however, there may be some walking, standing, bending, and carrying of light items. Work Environment: The work may be stressful due to the accelerated pace for several hours at a time during peak hours or on days that have a large volume of activity. See VA Directive and Handbook 5019, Employee Occupational Health Service for requirements.
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