Contact Representative

Serves as a Contact Representative, a beneficiary advocate and advisor providing service and assistance to Military Health System beneficiaries in understanding and obtaining benefits via the TRICARE program. Serves as a Beneficiary Counseling and Assistance Coordinator and Debt Collection Assistance Officer.

Duties:

• 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:

• 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:

• Only applicants who meet one of the employment authority categories below are eligible to apply for this job.
• 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

Specialized Experience:

• GS-06: One year of specialized experience which includes any two or more of the following: gathering and inputting data into a computer system, monitor referral data using automated and/or non-automated methods from external and internal reports, receive incoming calls, walk-in visits from patients, and enrollment processing.
• GS-07: One year of specialized experience which includes any two or more of the following; assisting and providing information in the referral and authorization process with specialty care referral review, coordination, tracking, and beneficiary counseling; answer routine questions from beneficiaries related to medical insurance claim submissions, collections, and case resolution processes.
• GS-08: One year of specialized experience which includes any two or more of the following; assisting beneficiaries by resolving or correcting discrepancies of existing medical claims, providing regulatory healthcare guidance to the patient population on their rights, benefits, privileges, access to care and available eligibilities, counseling beneficiaries on a broad range of available health benefit programs.

Time in Grade Requirement:

• GS-06: 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-07: 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-08: 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).

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.
• This position requires a 1 year probationary period during which the agency evaluates your fitness and whether your continued employment advances the public interest.
• 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.

A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding.