Health Systems Specialist

Summary

About the Position: This position is being filled in one of the following places: Falls Church, VA, San Diego, CA, San Antonio, TX, Havelock, NC, or Aurora, CO. This is a Direct Hire Solicitation.

Duties

• Reviews and analyzes beneficiary case trends to identify systemic issues affecting TRICARE health service delivery.
• Provides expert technical assistance to DHA entities, MTF leadership, Uniformed Services, contractor representatives, and customer service personnel regarding TRICARE policy interpretation, operational requirements, and program procedures.
• Conducts independent analyses of TRICARE program implementation, operational performance, and compliance with federal and DoD requirements.
• Evaluates cases involving claims processing, enrollment, referral and authorization workflows, third-party liability, debt collection activities, and eligibility discrepancies to determine operational causes and recommend improvements.
• Develops and presents briefings, reports, and educational materials explaining TRICARE program updates, administrative changes, and system processes.

Qualifications

Who May Apply: US Citizens 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. Specialized Experience: One year of specialized experience which includes developing operational strategies to resolve complex contract performance issues; recommending formal policy revisions to address systemic healthcare program deficiencies; and assessing healthcare program delivery models to ensure compliance with federal requirements. This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-11). Some federal jobs allow you to substitute your education for the required experience in order to qualify. For this job, you must meet the qualification requirement using experience alone--no substitution of education for experience is permitted.