Contact Representative

Job Title

Contact Representative

Major Duties and Responsibilities

Determine and adjudicate Veterans' eligibility and enrollment for VA health care benefits.

Apply Title 38 regulations, VHA policies, federal laws, and agency guidance to eligibility determinations.

Process enrollment applications and requests received in person, by telephone, fax, mail, online, or referral.

Update 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 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 related to 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 as required for accurate billing and continued eligibility.

Generate patient data cards and assist with Veterans Health Identification Card processes.

Provide administrative support to the Emergency Department, including patient registration and verification of entitlement to care.

Update insurance information using applicable systems and print and verify patient armbands and labels.

Monitor the Emergency Department tracking board, direct patients, route inquiries, and coordinate with clinical and administrative 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 concerning 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 personally identifiable information and protected health information in all transactions and communications.

Maintain effective working relationships with individuals 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.

Work Schedule: Monday-Friday, 8:00 a.m.- 4:30 p.m.

This is not a virtual position.

Position Description/PD#: PD92716A

Relocation/Recruitment Incentives: Not Authorized

Critical Skills Incentive (CSI): Not Approved

Permanent Change of Station (PCS): Not Authorized