Medical Reimbursement Technician

TO QUALIFY FOR THIS POSITION AT THE GS-5 GRADE LEVEL, YOU MUST MEET ONE OF THE FOLLOWING CRITERIA: SPECIALIZED EXPERIENCE: You must possess at least one (1) full year of specialized experience that equipped you with the particular knowledge, skills, and abilities to perform successfully the duties of the position, and that is typically in or related to the work of this Medical Reimbursement Technician position.

To be creditable, specialized experience must have been equivalent to at least the next lower grade level (GS-4) of Federal service. Specialized experience includes verifying medical insurance coverage and patient eligibility; reviewing and processing medical billing claims; entering and updating insurance and billing information in electronic databases; maintaining billing and payment records; and responding to inquiries regarding insurance coverage, billing, and account status.

NOTE: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week. A full year of work is considered to be 35-40 hours of work per week. ~OR~ SUBSTITUTION OF EDUCATION FOR EXPERIENCE: You must have successfully completed four (4) years of education above the high school level in any field which high school graduation or the equivalent is the normal prerequisite.

This education must have been obtained in an accredited business, secretarial or technical school, junior college, college, or university. One year of full-time academic study is defined as 30 semester hours, 45 quarter hours, or the equivalent in a college or university, or at least 20 hours of classroom instruction per week for approximately 36 weeks in a business, secretarial, or technical school. NOTE: Transcripts (unofficial or official) must be submitted with your application materials.

Education cannot be credited without documentation. ~OR~ COMBINATION OF EXPERIENCE AND EDUCATION: You must possess equivalent combinations of successfully completed post-high school education (beyond the second year) and specialized experience, as described above, which meet the total experience requirements for this grade level. This education must have been obtained in an accredited business, secretarial or technical school, junior college, college, or university.

NOTE: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week. A full year of work is considered to be 35-40 hours of work per week. Transcripts (unofficial or official) must be submitted with your application materials. Education cannot be credited without documentation.

TO QUALIFY FOR THIS POSITION AT THE GS-6 GRADE LEVEL, YOU MUST MEET THE FOLLOWING CRITERIA: SPECIALIZED EXPERIENCE: You must possess at least one (1) full year of specialized experience that equipped you with the particular knowledge, skills, and abilities to perform successfully the duties of the position, and that is typically in or related to the work of this Medical Reimbursement Technician position.

To be creditable, specialized experience must have been equivalent to at least the next lower grade level (GS-5) of Federal service.

Specialized experience includes verifying medical insurance coverage and patient eligibility; reviewing and processing medical billing claims; entering and updating insurance and billing information in electronic databases; maintaining billing and payment records; responding to inquiries regarding insurance coverage, billing, and account status; researching and resolving billing discrepancies, claim denials, and payment issues; and reconciling accounts and following up on outstanding balances.

NOTE: Experience must be fully documented on your resume and must include job title, duties, month and year start/end dates AND hours worked per week. A full year of work is considered to be 35-40 hours of work per week. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.

THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION This position involves a multi-grade career ladder. The major duties listed below represent the full performance level of GS-06. At the GS-05 grade level, you will perform assignments of a more limited scope and with less independence. You will progressively acquire the background necessary to perform at the full performance level of GS-06.

Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher level work, and availability of funds. Duties include but may not be limited to the following: Validates claims for billing purposes, ensures eligibility, and refers questionable coding for review. Contacts insurance companies to confirm coverage, benefits, deductibles, copays, coinsurance, and authorization requirements. Reviews patient demographic and insurance information for accuracy.

Obtains and documents prior authorizations when required by the payer. Performs Medicare reimbursable billing activities in accordance with applicable requirements. Interprets third-party insurance policies, contractual provisions, and requirements for billing. Reviews and verifies insurance coverage and eligibility information for billing purposes. Reviews billing and account information to determine accuracy and appropriateness.

Responds to inquiries and correspondence concerning medical billing, insurance coverage, and account status. Processes medical billings in accordance with applicable diagnostic and procedural coding requirements. Uses office software applications, including Microsoft Access, Excel, and Word, to perform insurance verification, billing, and administrative functions. Organizes and completes assigned work in accordance with established timelines, priorities, and workload requirements.

Performs other related duties as assigned. Work Schedule: Monday - Friday, 8:00am - 4:30pm Recruitment & Relocation Incentives: Not authorized Critical Skills Incentive (CSI): Not approved Telework: This position may be authorized for telework. Telework eligibility will be discussed during the interview process.