Supervisory Program Specialist-Insurance Verification

Summary

This position is located in a Consolidated Patient Account Center (CPAC) in the organization of the Chief Operating Officer with the incumbent serving as the Insurance Verification Supervisor. The CPAC is a regionally consolidated business entity established to enhance revenue operations throughout the VHA network by standardization and consolidation of functions, and the integration of VHA and industry best practices.

Duties

• Duties: Implements processes and procedures for staff to contact insurance carriers. Reviews claims tracking files for proper pre-certification. Examines patient insurance files for accurate/current data. Provides guidance and assistance for the review of Explanation of Benefits (EOB) as necessary to identify insurance information. Monitor the integrity of an insurance file database by ascertaining that data is timely and accurate. Communicates/coordinates daily with the Utilization Review (UR) Nurses, collections staff, or billing specialist. Independently prepares reports, memorandum and other written products. Researches Third Party Joint Inquiry files for prior payments Work Schedule: Monday-Friday 8:00-4:30P Telework: Not Authorized Virtual: This is not a virtual position. Position Description/PD#: Supervisory Program Specialist-Insurance Verification/PD35889A and PD35889A Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized PCS Appraised Value Offer (AVO): Not Authorized

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 11/09/2026. Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-09 position you must have served 52 weeks at the GS-07. The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment. You may qualify based on your experience and/or education as described below: GS-09 Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-07 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Lead and coordinate program activities by assigning, monitoring, and reviewing work to ensure timely accomplishment of organizational goals and mission requirements. Apply knowledge of insurance programs, claims administration, policies, and regulations to provide technical guidance, resolve operational issues, and support program effectiveness. Communicate effectively with employees, customers, and management officials by presenting information, addressing concerns, facilitating collaboration, and providing clear recommendations on program matters. Ensure adherence to established policies, regulations, and procedures through oversight of program operations, analysis of performance outcomes, and implementation of process improvements to enhance efficiency and customer service. Note: Evidence of specialized experience must be supported by detailed documentation of duties performed in positions held on your resume. You must provide work experience information such as hours per week, salary, and starting/ending dates of employment (month and year format) to establish you have one (1) full year of Specialized Experience at or comparable to the required grade level. OR Education (TRANSCRFIPT REQUIRED): Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have a Master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related. Such education must demonstrate the knowledge, skills, and abilities necessary to do the work. OR Combination (TRANSCRIPTS REQUIRED): Applicants may also combine education and experience to qualify at this level. You must have equivalent combinations of successfully completed graduate education and specialized experience directly related to the work of the Supervisory Program Specialist position, which may be substituted to meet the experience requirements for the GS-09 position. You will be rated on the following Competencies for this position: Accountability Customer Service Decisiveness Flexibility Interpersonal Skills Problem Solving Resilience 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; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates dire…

Education

A transcript must be submitted with your application if you are basing all or part of your qualifications on education. Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.