Prior Authorization Representative

Job TitleAuthorization Quality Review SpecialistJob DescriptionThe purpose of this position is to measure individual performance quality as well as identify training needs through the review and assessment of completed compensation and pension claims. Duties include, but are not limited to:Performs individual quality reviews to determine the authorization quality level of individual VSRs for purposes of individual performance standards in accordance with an established monthly schedule.Conducts focused "in-process reviews" for cases to determine the accuracy of claims action taken. (Such reviews are for station-level feedback and improvement only, not used for individual performance standard purposes.)Responsible for sharing authorization quality trend information with management on an ongoing basis and with the VSRs during training sessions.Reviews products or activities for quality of performance and enters the results into the on-line STAR checklists.Evaluates and identifies deficiencies of all elements of a claim from evidence development, income and dependency issues, to award processing and authorization. Provides an explanation of errors and includes comments where attention is warranted.Prepares STAR data reports and provides to personnel in the regional office who are authorized to request and receive such reports.Develops various quality assurance processes with emphasis on work procedures and techniques that address unique work conditions and practices.Ensures all program requirements imposed by Compensation Service and/or the Court of Appeals for Veterans Claims are met or implemented.Promotion Potential: The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met. Selection at a lower grade level does not guarantee promotion to the full performance level. The grade progression for this position is GS-11, GS-12.Work Schedule: Full time, Monday - Friday. Hours to be determined by hiring office.Compressed/Flexible: May be available as determined by the hiring office.Telework: This position is eligible for situational (ad hoc) telework only. The selectee is required to report to the official duty station each scheduled workday. Telework may be approved only on a case-by-case basis with supervisory approval. Routine or recurring telework is not authorized for this position.Virtual: This is not a virtual position.Position Description/PD#: Veterans Service Representative (Authorization Quality Review Specialist); PD41680A and PD37136ARelocation/Recruitment Incentives: Not AuthorizedFinancial Disclosure Report: Not Required