Health Systems Specialist Jobs

Job TitleJob RequirementsSan Diego, CA Aurora, CO Havelock, NC San Antonio, TX Falls Church, VA Secret Polygraph Unspecified Career Level not specified Salary not specifiedJob DescriptionDutiesReviews and analyzes beneficiary case trends to identify systemic issues affecting TRICARE health service delivery.Provides expert technical assistance to DHA entities, MTF leadership, Uniformed Services, contractor representatives, and customer service personnel regarding TRICARE policy interpretation, operational requirements, and program procedures.Conducts independent analyses of TRICARE program implementation, operational performance, and compliance with federal and DoD requirements.Evaluates cases involving claims processing, enrollment, referral and authorization workflows, third-party liability, debt collection activities, and eligibility discrepancies to determine operational causes and recommend improvements.Develops and presents briefings, reports, and educational materials explaining TRICARE program updates, administrative changes, and system processes.Requirements Conditions Of EmploymentAppointment may be subject to a suitability or fitness determination, as determined by a completed background investigation.This position requires the incumbent be able to obtain and maintain a determination of eligibility for a Secret security clearance or access for the duration of employment. A background investigation and credit check are required.Qualifications Who May Apply: US Citizens In order to qualify, you must meet the experience requirements described below. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; student; social). You will receive credit for all qualifying experience, including volunteer experience. Your resume must clearly describe your relevant experience; if qualifying based on education, your transcripts will be required as part of your application. Additional information about transcripts is. Specialized Experience: One year of specialized experience which includes 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 to ensure compliance with federal requirements. This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-11). Some federal jobs allow you to substitute your education for the required experience in order to qualify. For this job, you must meet the qualification requirement using experience alone--no substitution of education for experience is permitted. Education This job does not have an education qualification requirement. Additional informationMale applicants born after December 31, 1959 must complete a Pre-Employment Certification Statement for Selective Service Registration.You will be required to provide proof of U.S. Citizenship.This position requires a 1 year probationary period during which the agency evaluates your fitness and whether your continued employment advances the public interest. In making this determination, the agency may consider your performance and conduct; agency needs and interests; whether your continued employment supports organizational or Government goals; and whether it promotes the efficiency of the Federal service. Continued employment requires written certification that it advances the public interest.Direct Deposit of Pay is required.Selection is subject to restrictions resulting from Department of Defense referral system for displaced employees.Multiple positions may be filled from this announcement.Salary includes applicable locality pay or Local Market Supplement.If you have retired from federal service and you are interested in employment as a reemployed annuitant, see the information in the information sheet.Payment of Permanent Change of Station (PCS) costs is not authorized, based on a determination that a PCS move is not in the Government interest.