Contact Representative

The primary purpose of this position is to respond to basic questions and resolve issues pertaining to administrative support of medical center pharmacies and other related services to veterans, veteran family members and/or representatives, the public, and VA employees.

Duties

Major duties include, but are not limited to:

* Places outbound telephone calls and answers inbound telephone calls concerning billing inquiries, responds to questions and concerns, and clarifies billing determinations made by the pharmacy technician review team.

* Explains VA standards on secondary/adjunct conditions and the process of adjudication for additional or worsening SC conditions as well as dispute procedures.

* Responds to questions and concerns involving complex billing issues.

* Places and/or receives telephone calls and provides information about VA and related non-VA benefits available to Veterans and their dependents and beneficiaries. Calls involve a broad range of topics and include first party and third-party billing and debt collection, preregistration, Veteran record updates, Veterans' benefits, eligibility requirements, and credit card payments.

* Provides information concerning how to complete annual income means/copay tests and their importance in the determination of pharmacy prescription copayment exemptions.

* Reviews master record information contained within the Veterans Health Information Systems & Technology Architecture (VistA) system, Veterans Health Administration Enrollment System (VES), and Electronic Health Record (EHR).

* Explains in detail the process of filing a claim for benefits, eligibility requirements, repayment plans, and waivers, and advises what forms, evidence, and documentation must be submitted, along with other relevant information needed for each action.

* Prepares well-defined case notes when additional actions or referrals are indicated, available resources are insufficient to answer the caller's inquiry, and/or additional research is required.

* Determines the most appropriate action or identifies alternatives in resolving issue(s) through in-depth research, interpretation and analysis of master record information contained within VistA, Computerized Patient Record System (CPRS), EHR, Veteran Patient Statement (VPS), VES, Consolidated Mail Outpatient Pharmacy (CMOP), Customer Relationship Management (CRM) systems and other applicable resources and guidelines during telephone interactions.

Work Schedule:

Full-time, 40 hours per week, Monday through Friday, 8-hour shift between 7:00 am - 4:30 pm. Official tour of duty will be selected based on business needs.

Remote:
This position is not authorized for Remote work.

Telework:
This position is not authorized for Telework.

Virtual:
This position may be authorized for Virtual work. Virtual eligibility will be discussed during the interview process.

Definition of Virtual work:
Employee works outside of original hiring duty station at VA-owned or leased space.

Return to Office (RTO): RTO exemptions will be considered and a determination will be made as part of the selection and onboarding process.

Position Description/PD#:
Contact Representative/PD06845A

Relocation/Recruitment

Incentives:

Not Authorized

Critical Skills Incentive (CSI):
Not Authorized

Permanent Change of Station (PCS):
Not Authorized

PCS Appraised Value Offer (AVO):
Not Authorized