Health Systems Specialist
About The Position
The Health Systems Specialist reviews and analyzes beneficiary case trends to identify systemic issues affecting TRICARE health service delivery. The role provides expert technical assistance to Defense Health Agency (DHA) entities, military treatment facility leadership, Uniformed Services, contractor representatives, and customer service personnel on TRICARE policy interpretation, operational requirements, and program procedures. The specialist conducts independent analyses of TRICARE program implementation, operational performance, and compliance with federal and Department of Defense requirements. The position evaluates cases involving claims processing, enrollment, referral and authorization workflows, third-party liability, debt collection activities, and eligibility discrepancies to identify operational causes and recommend improvements. The specialist also develops and presents briefings, reports, and educational materials explaining TRICARE program updates, administrative changes, and system processes. The position is being filled in Falls Church, Virginia; San Diego, California; San Antonio, Texas; Havelock, North Carolina; or Aurora, Colorado. It is a direct-hire solicitation. Appointment may require a suitability or fitness determination, and the incumbent must obtain and maintain eligibility for a Secret security clearance or access. A background investigation and credit check are required.
Requirements
- U.S. citizenship.
- One year of specialized experience developing operational strategies to resolve complex contract performance issues, recommending formal policy revisions to address systemic healthcare program deficiencies, and assessing healthcare program delivery models for compliance with federal requirements. This experience is typical of work at the GS-11 level.
- Qualifying experience must be demonstrated through experience; education may not substitute for the experience requirement.
- Ability to obtain and maintain eligibility for a Secret security clearance or access for the duration of employment.
- Successful completion of any required suitability or fitness determination, background investigation, and credit check.
- Proof of U.S. citizenship.
- Direct deposit of pay is required.
Responsibilities
- Review and analyze beneficiary case trends to identify systemic issues affecting TRICARE health service delivery.
- Provide technical assistance to DHA entities, military treatment facility leadership, Uniformed Services, contractor representatives, and customer service personnel on TRICARE policy, operational requirements, and program procedures.
- Analyze TRICARE program implementation, operational performance, and compliance with federal and DoD requirements.
- Evaluate cases involving claims processing, enrollment, referral and authorization workflows, third-party liability, debt collection, and eligibility discrepancies; identify operational causes and recommend improvements.
- Develop and present briefings, reports, and educational materials about TRICARE program updates, administrative changes, and system processes.
Benefits
- Federal employee benefits are referenced, but specific benefits are not detailed in the posting.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
