Contact Representative

Duties
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• Provide beneficiary counseling and assistance to ensure health benefit information is available to eligible beneficiaries.
• Act as liaison to assist beneficiaries regarding the TRICARE program, coordinating with medical staff, Tricare Area office service centers, Managed Care Support Contractors, claims processor, and other concerned parties.
• Coordinate briefings for the servicing community to include active duty, family members, newcomers, pre-deployment and post deployment.
• Utilize various healthcare software applications to verify patient eligibility and complete patient enrollment.
• Track medical claim cases using a system to categorize caseload by data elements for timely resolution.
• Develop recommendations to change or modify existing procedures or policies that will subsequently provide more effective and improved health care to the beneficiary category populations.
• Provide information to resolve problems involving access, payment of bills, and eligibility issues concerning medical care under the TRICARE program.
• Interview or counsel customers.

Requirements
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Conditions of employment

• Appointment may be subject to a suitability or fitness determination, as determined by a completed background investigation.
• This position requires the incumbent be able to obtain and maintain a determination of eligibility for a Secret security clearance or access for the duration of employment. A background investigation and credit check are required.
• This position has mandatory seasonal Influenza vaccination requirements and is subject to annual seasonal Influenza vaccinations unless otherwise exempted for medical or religious reasons (documentation of exemption must be provided upon hire).
• Immunization screening is required. Hepatitis B immunization is required for all positions with direct patient contact. Applicants may be required to show proof of other immunizations depending on the type of position.
• This position requires the incumbent to have Tuberculosis testing.
• This position may require the incumbent to work on call during irregular work hours which may include evenings, weekends, holidays, and/or varying work schedules.
• This position has been designated Mission Essential. In the event of severe weather conditions or other such emergency type situations, the incumbent is required to report to work or remain at work as scheduled to support mission operations.
• This position requires the completion of a pre-employment Physical Examination and an annual examination thereafter to ensure the continued, required level of physical health and ability or fitness to perform the duties of the position.
• Moderate to heavy lifting up to 50 pounds may be required.

Qualifications

Who May Apply: Only applicants who meet one of the employment authority categories below are eligible to apply for this job. You will be asked to identify which category or categories you meet, and to provide documents which prove you meet the category or categories you selected.

• Current Civilian Employees of the Defense Health Agency (DHA)
• Current Permanent Department of Defense (DoD) Civilian Employee
• Domestic Defense Industrial Base/Major Range and Test Facilities Base Civilian Personnel Workforce
• Interagency Career Transition Assistance Plan
• Land Management Workforce Flexibility Act
• Military Spouses, under Executive Order (E.O.) 13473
• Priority Placement Program, DoD Military Reserve (MR) and National Guard (NG) Technician Eligible
• Priority Placement Program, DoD Military Spouse Preference (MSP) Eligible
• Priority Placement Program, DoD MR and NG Preference Eligible Tech Receiving Disability Retirement
• Priority Placement Program, DoD Retained Grade Preference Eligible
• Veterans Employment Opportunity Act (VEOA) of 1998

In order to qualify, you must meet the experience requirements described below. 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; religious; spiritual; community; student; social). You will receive credit for all qualifying experience, including volunteer experience. Your resume must clearly describe your relevant experience; if qualifying based on education, your transcripts will be required as part of your application. Additional information about transcripts is in this document .

GS-6 Grade Level:
Specialized Experience: One year of specialized experience which includes 1) perform referral screening and appointing for referrals, 2) ensure all specialty referrals are screened, processed and appointed in accordance with local policies, 3) receive incoming calls and walk-in visits from patients, and 4) enrollment processing. This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-05).

Time in Grade Requirement: Applicants who have held a General Schedule (GS) position within the last 52 weeks must have 52 weeks of Federal service at the next lower grade or equivalent (GS-05).

GS-7 Grade Level:
Specialized Experience: One year of specialized experience which includes 1) answer routine questions from beneficiaries related to medical insurance claims, such as submission, collections, and case resolution processes, 2) assist with counseling beneficiaries on a broad range of healthcare related benefits, and 3) utilize automated healthcare database to enter and retrieve patient data. This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-06).

Time in Grade Requirement: Applicants who have held a General Schedule (GS) position within the last 52 weeks must have 52 weeks of Federal service at the next lower grade or equivalent (GS-06).

GS-8 Grade Level:
Specialized Experience: One year of specialized experience which includes 1) assist beneficiaries by resolving or correcting discrepancies of existing medical claims, 2) provide regulatory healthcare guidance to the patient population on their rights, benefits, privileges, access to care and available eligibilities, 3) counsel beneficiaries on a broad range of available health benefit programs, and 4) utilize an automated healthcare database to enter and retrieve patient data. This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-07).

Time in Grade Requirement: Applicants who have held a General Schedule (GS) position within the last 52 weeks must have 52 weeks of Federal service at the next lower grade or equivalent (GS-07).

Education

This job does not have an education qualification requirement.

Additional information

• Male applicants born after December 31, 1959 must complete a Pre-Employment Certification Statement for Selective Service Registration.
• You will be required to provide proof of U.S. Citizenship.
• One year trial/probationary period may be required.
• Direct Deposit of Pay is required.
• Selection is subject to restrictions resulting from Department of Defense referral system for displaced employees.
• Recruitment or relocation incentives MAY be authorized for highly qualified candidates.
• Multiple positions may be filled from this announcement.
• Salary includes applicable locality pay or Local Market Supplement.
• If you have retired from federal service and you are interested in employment as a reemployed annuitant, see the information in the Reemployed Annuitant information sheet.
• Payment of Permanent Change of Station (PCS) costs is not authorized, based on a determination that a PCS move is not in the Government interest.
• Advanced In-hire May be authorized for highly qualified candidates.
• Advanced leave accrual May be authorized.
• Student loan repayment May be authorized.
• Management may select at any of the grade levels announced. Duties described reflect the full performance GS-08 level. Duties will be performed in a developmental capacity under close supervision. This recruitment provides promotion opportunity to the target grade of the position without further competition when selectee is eligible and recommended by management.

Reasonable Accommodation (RA) Requests : If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://appsupport.usastaffing.gov/hc/en-us/sections/28980686389652-Reasonable-Accommodation-Information