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Claims Assistant

Applicants who applied for MS-15-THI-1311733BU must re-apply to be considered for this position.
The Claims Assistant is responsible for the day-to-day administration of non-VA services as mandated by the policies and procedures of the Veterans Health Administration.
The Non-VA Care Program is a comprehensive program that includes the fiscal and administrative management of non-VA authorized and unauthorized medical care.
The position requires a broad range of skills and expertise that crosses numerous activities that include an understanding medical terminology, medical billing, patient scheduling, legal entitlements to VHA health care services, and customer service skills.
Incumbent will:
o Reviews medical record documents and interprets the kinds of care being requested.
o Reviews and determines veteran's eligibility for Non VA Careo Reviews Non VA Care Medical claims and associated documents to verify that services rendered were authorized.
o Process Non VA Care requests (reviews consults, obtains approval/disapproval, creates an authorization, entering information and data into the Fee Basis Claims System.
o Scans and indexes Non VA Care medical records.
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o Verifies Non VA Care Claims.
o Updates, monitors and tracks all authorized Medical Non VA Care services in the Fee Basis Claims System.
o Schedules and checks out appointments in the VistA Appointment Management System.
o Ensures all required clinical documentation is received and appropriately scanned in VistA Imaging and/or the associated CPRS Non VA Care Consult is closed.
o Conducts research to determine authorization and claim status.
o Provides general administrative support for the office, such as, making copies, gathering information from various systems for special reports.
o Performs research on inquiries by examination of facts in resolving problemso Prepares, mails and/or faxes letters to Veterans and Non VA Care Vendors.
o Maintains close contact with medical and clerical staff in various units and with outside vendors to resolve delays and misunderstanding in the medical administrative aspect of providing care.
o Resolves issues and answers questions (orally or in writing) presented by Veterans, Vendors, congressional offices and/or Veteran Service Organizations regarding claims and their status.
o Prints, sorts and mails Vendor and Veteran denial letterso Works cooperatively with others to generate ideas/suggestions.
o Coordinates with others to accomplish work-related activities.
Work Schedule:
Monday - Friday 8:
00 am to 4:
30 pmRelocation Expenses:
Relocation expenses are not authorized for this position.
Bargaining Unit:
Yes

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