Health Care Referral Coordinator (OA)

Employer
USAJobs
Location
Fort Myer, Virginia
Posted
Mar 04, 2021
Closes
Mar 07, 2021
Function
Program Manager
Hours
Full Time
Duties

Summary

About the Position: As a Health Care Referral Coordinator (OA), you will provide authoritative information concerning health care benefits and entitlements (i.e. TRICARE and HUMANA) for beneficiaries (Military and Military Dependents). This position is located at the U.S. Army Andrew Rader Medical Clinic in Fort Myer, Virginia.
Learn more about this agency

Responsibilities

  • Serve as a subject matter expert for the Supplemental Care Program and Medicare Referral Program (i.e. TRICARE and Humana), providing referral management, claims management, customer service, and resource identification.
  • Receive referrals for active duty and beneficiaries for health care (i.e. TRICARE and Humana) to include civilian and military provider referrals, diagnostic testing and durable medical equipment to be supplied by civilian and military resources.
  • Review referrals for completeness of required medical information and verify if services are a covered benefit under TRICARE and Humana standards.
  • Oversee claims and assist in budget execution and reporting for supplemental care funds, used primarily to purchase medical lab tests, home health care, second opinions from physicians, and diagnostic testing various civilian health facilities.
  • Monitor expenditures, ensure funds requested are available, informs supervisor if additional funds are required; Receive and verify invoices for accuracy, and coordinate with requestor to ensure items or services were received.
  • Serves as an advisor to Active duty and beneficiaries; assist individuals in obtaining health care benefits and preparing appeals when benefits are denied (i.e. TRICARE and Humana).
  • Advise on TRICARE, HUMANA, CHAMPVA, Medicare, Medicaid, Delta Dental procedures and benefits; to include Supplemental Health Care Program, US Health Benefit Program, Program For Persons with Disabilities, and Veterans Affairs.
  • Understand the Defense Eligibility Enrollment Reporting System (DEERS) and the Composite Health Care System (CHCS) in order to access information and assist beneficiaries (i.e. TRICARE and HUMANA).


Travel Required

25% or less - You may be expected to travel 25% of the time for this position.

Supervisory status
No

Promotion Potential
7

Requirements

Conditions of Employment

  • Appointment may be subject to a suitability or fitness determination, as determined by a completed background investigation.
  • In the event of severe weather conditions or other such emergency type situations (natural or man-made disaster), this position requires you to report to work or remain at work as scheduled to support mission operations.
  • This position is subject to a two year probationary period unless the appointee has previously met the requirements as described in 5 CFR Part 315.
  • This position is subject to screening and update of required immunizations unless exempted for medical or administrative reasons in accordance with Army Regulation 40-562, Chapters 3 and 4.
  • This position has a mandatory seasonal influenza vaccination requirement and is subject to annual vaccination.
  • This position requires a typing proficiency of at least 40 words per minute (WPM) based on a 5 minute sample with 3 or fewer errors.


Qualifications

Who May Apply: US Citizens

In order to qualify, you must meet the education and/or 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 .

Specialized Experience includes receiving civilian and military provider healthcare referrals (i.e. TRICARE and HUMANA) for military personnel and/or their beneficiaries; verifying service coverage of benefits under a health care plan (i.e. TRICARE, HUMANA, Medicare, Medicaid, and Supplemental Care); interpreting regulations and policies relative to medical entitlements.

You will be evaluated on the basis of your level of competency in the following areas:
  • Benefits and Work Life Programs
  • Customer Service
  • Manages and Organizes Information
  • Oral Communication


Education

FOREIGN EDUCATION: If you are using education completed in foreign colleges or universities to meet the qualification requirements, you must show the education credentials have been evaluated by a private organization that specializes in interpretation of foreign education programs and such education has been deemed equivalent to that gained in an accredited U.S. education program; or full credit has been given for the courses at a U.S. accredited college or university. For further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html

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.
  • Two 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.
  • You may claim military spouse preference.
  • If a MSP applicant is determined best qualified and selected, placement must be at the full performance level for priority consideration.
  • Multiple positions may be filled from this announcement.
  • Salary includes applicable locality pay or Local Market Supplement.
  • Interagency Career Transition Assistance Program (ICTAP). If you are a Federal employee in the competitive service and your agency has notified you in writing that you are a displaced employee eligible for ICTAP consideration, you may receive selection priority for this position. To receive selection priority, you must: (1) meet ICTAP eligibility criteria (2) be rated well-qualified for the position and; (3) submit the appropriate documentation to support your ICTAP eligibility. To be considered well-qualified and receive selection priority applicants must satisfy all qualification requirements for the position and receive a score of 90 or above. Additional information about the program is on OPM's Career Transition Resources website.
  • If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application .
  • 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.


How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

Once the announcement has closed, a review of your application package (resume, supporting documents, and responses to the questionnaire) will be used to determine whether you meet the qualification requirements listed on this announcement. If you are minimally qualified, your résumé and supporting documentation will be compared against your responses to the assessment questionnaire to determine your level of experience. If, after reviewing your résumé and/or supporting documentation, a determination is made that you have inflated your qualifications and/or experience, you may lose consideration for this position. Please follow all instructions carefully when applying, errors or omissions may affect your eligibility.

You should list any relevant performance appraisals and incentive awards in your resume as that information may be taken into consideration during the selection process. If selected, you may be required to provide supporting documentation.

Basis for Rating: Qualified candidates will be assigned to one of three quality categories: Best Qualified, Highly Qualified and Qualified. Veteran preference eligibles are listed ahead of non-preference eligibles within each quality category.
  • Best Qualified. Candidates in this category possess exceptional skills and experience to exceed well above the minimum requirements for the announced position.
  • Highly Qualified. Candidates in this category possess good skills and experience above the minimum requirements for the announced position.
  • Qualified. Candidates in this category meet the minimum experience requirements for the announced position.


Background checks and security clearance

Security clearance
Confidential

Drug test required
No

Position sensitivity and risk
Non-sensitive (NS)/Low Risk

Trust determination process
Credentialing

Required Documents

The documents you are required to submit vary based on whether or not you are eligible for preference in federal employment. A complete description of preference categories and the associated required documents is in the Applicant Checklist (External) .

As described above, your complete application includes your resume, your responses to the online questionnaire, and documents which prove your eligibility to apply. If you fail to provide these documents, you will be marked as having an incomplete application package and you will not be considered any further.

1. Your resume:
  • Your resume may be submitted in any format and must support the specialized experience described in this announcement.
  • If your resume includes a photograph or other inappropriate material or content, it will not be used to make eligibility and qualification determinations and you may not be considered for this vacancy.
  • For qualifications determinations your resume must contain hours worked per week and the dates of employment (i.e., HRS per week and month/year to month/year or month/year to present). If your resume does not contain this information, your application may be marked as incomplete and you may not receive consideration for this position.
  • For additional information see: What to include in your resume .
2. Other supporting documents:
  • Cover Letter, optional
  • Most recent Performance Appraisal, if applicable.
NOTE: Documents submitted as part of the application package, to include supplemental documents, may be shared beyond the Human Resources Office. Some supplemental documents such as military orders and marriage certificates may contain personal information for someone other than you. You may sanitize these documents to remove another person's personal information before you submit your application. You may be asked to provide an un-sanitized version of the documents if you are selected to confirm your eligibility.

If you are relying on your education to meet qualification requirements:

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education .

Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

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