Contact Representative

Veterans Health Administration • Dayton, OH

1d • Onsite

About The Position

Serves as a Contact Representative in the Dayton VA Medical Center's Enrollment and Eligibility Unit. Determines Veterans' eligibility and enrollment for VA health care, conducts financial assessments, processes hardship cases, validates military, income, insurance, and demographic information, and supports Emergency Department registration. Uses VES and related systems, explains benefits, prepares correspondence, protects personally identifiable information (PII) and protected health information (PHI), and coordinates with Veterans and partner agencies.

The position applies Title 38 regulations, VHA policies, federal laws, and agency guidance to eligibility determinations. It processes applications and requests received in person, by telephone, fax, mail, online, or referral; researches complex eligibility issues; and supports special programs and Emergency Department administrative operations. It also communicates eligibility and benefits information to Veterans and others, prepares correspondence and presentations, and coordinates privacy-related identity and demographic updates.

Work schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. This is not a virtual position. The work is mainly sedentary, but may involve walking, standing, bending, driving an automobile, and frequently carrying case files or similar materials. No special physical effort or ability is required. The position requires one year of specialized experience equivalent to at least GS-06. There is no education requirement.

Requirements

• U.S. citizenship is required.
• Selective Service registration is required for males born after December 31, 1959.
• Must be able to complete a background/security investigation and the online onboarding process.
• Participation in the seasonal influenza vaccination program is required for VA Health Care Personnel.
• Must serve a one-year probationary period or two-year trial period, as applicable.
• For current or former Federal employees subject to time-in-grade requirements, one year at GS-06 is required for the GS-07 position, with supporting SF-50 documentation.
• One year of specialized experience equivalent to at least GS-06, including administrative support in healthcare benefits, eligibility, enrollment, insurance, or related customer service; applying laws, regulations, and policies to eligibility decisions; processing applications, assessments, hardship requests, and personal-information updates; researching records and resolving complex issues; using automated systems and databases; reviewing data and correcting discrepancies; supporting emergency registration and patient flow; preparing correspondence and reports; explaining benefits and requirements; protecting PII and PHI; coordinating with agencies and partners; and exercising accuracy, judgment, tact, and discretion.
• Demonstrated competencies in Customer Service, Health Information Exchange, and Organization Awareness.

Responsibilities

• Determine and adjudicate Veterans' eligibility and enrollment for VA health care benefits using applicable laws, regulations, policies, and guidance.
• Process enrollment applications and requests received in person, by telephone, fax, mail, online, or referral.
• Update and validate Veteran demographic, military service, insurance, income, and eligibility information in VES and related systems.
• Conduct financial assessments, means tests, pharmacy copay exemption reviews, and hardship determinations.
• Explain eligibility decisions, enrollment requirements, copayments, benefits, and available services to Veterans and representatives.
• Research and resolve complex eligibility issues, including those involving character of discharge, income verification, military service, and special programs.
• Process and track Other Than Honorable discharge adjudications and submit applicable referrals and forms to the VA Regional Office.
• Assist with eligibility determinations for mental health, humanitarian care, presumptive eligibility, MST-related services, and other special programs.
• Apply eligibility provisions for OEF/OIF/OND, Caregiver, Camp Lejeune, Agent Orange, PACT Act, COMPACT Act, Burn Pit Registry, Project SHAD, and other emphasis programs.
• Research Veteran records using VES, VIS, VBMS, DPRIS, ILER, MPI, SHARE, EHRM, and other VA systems.
• Validate data, execute transmissions, monitor workloads, and correct discrepancies affecting billing, workload credit, and patient care.
• Identify, verify, and enter health insurance information; scan insurance cards; and research missing payer information.
• Review and update insurance and income information for accurate billing and continued eligibility.
• Generate patient data cards and assist with Veterans Health Identification Card processes.
• Provide Emergency Department administrative support, including patient registration and verification of entitlement to care.
• Update Emergency Department insurance information, print and verify patient armbands and labels, monitor the tracking board, direct patients, route inquiries, and coordinate with staff.
• Respond to inquiries from Veterans, family members, VA employees, other agencies, and community partners.
• Coordinate patient-related information and administrative needs with physicians, nurses, social workers, service officers, and other staff.
• Prepare, review, and issue written correspondence regarding complex eligibility, enrollment, and benefits inquiries.
• Conduct benefits and enrollment presentations for Veterans, representatives, service organizations, and community groups.
• Serve as a liaison with the VHA Privacy Officer and process official name and gender-assignment changes in accordance with applicable requirements.
• Gather and route legal documentation and signed requests for privacy, identity, and demographic updates.
• Protect PII and PHI in all transactions and communications.
• Maintain effective working relationships with people from diverse socioeconomic, cultural, and educational backgrounds.
• Prioritize and complete work accurately in a fast-paced environment while exercising sound judgment, initiative, tact, and discretion.

Benefits

• Comprehensive federal employee benefits package for employees and their families.
• Potential credit toward annual leave accrual based on prior work or military service experience, subject to request and approval before appointment.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed