Beneficiary Services Representative

3 months ago

Portsmouth, United States HealthCare Resolution Services Full time
Description

This individual serves as the Physical Evaluation Board Liaison Officer (PEBLO) for the medical treatment facility (MTF) and its geographic area of responsibility. Provides Disability Evaluation System (DES) guidance in accordance with established DoD guidelines, , data collection, medical coordination, Service member/commander/stakeholder advising, and procedural work related to Medical Evaluation Board (MEB) processing and Temporary Disability Retired List (TDRL) reevaluations in accordance with applicable instructions, regulations and directives. Liaison support is provided to active duty and Reserve Component (RC) members and commanders on program requirements, military benefits, legal rights, and the appeals process. Coordinates Aeromedical evacuation or other patient travel requirements, fitness for duty determinations, line of duty (LOD) and other program requirements related to the DES. Provides Physical Evaluation Board (PEB) findings to service member and medical staff. Tracks each DES case from referral to final disposition. Guides the Service member throughout the DES process.

Essential Functions

  • Ability to plan, organize and manage functions and staff within an MTF to meet program objects. Knowledge of the military healthcare organizational structure, major issues, policies, procedures and operations related to the management of the healthcare delivery systems.
  • In depth knowledge, experience and training to handle and solve complex cases that arise when addressing fitness for duty or physical disability evaluation issues.
  • Tact, diplomacy, and restraint in counseling and and explaining entitlements, benefits and responsibilities to all customers.
  • Effective interpersonal communication skills to effectively accomplish the IDES process.
  • Master of oral and written communication and customer service principles, methods, practices and techniques analytic methods, to include research tools and statistical analysis and, interpersonal relations practices.
  • Ability to communicate effectively both orally and in writing to motivate, train, and work effectively with a diverse workforce. Must be able to draw realistic conclusions and recommend viable solutions.
  • Ability to gather data from various sources, analyze date, statistical analysis, prepare statistical reports and recommendations for improvement.
  • Skill in applying fact finding, analytical, and problem solving methods and techniques.
  • Knowledge of DES processing regulations, instructions, procedures, and policies to assure timely case processing.
  • Practical knowledge and understanding of the TRICARE program
Performance Outcomes
  • Responsible for obtaining, assembling and forwarding all required documents and records for the active duty, AFRC and ANG to the Veteran Affairs Medical Service Coordinator, the local MEB, the IPEB, the FPEB and other IDES stakeholders in accordance with regulatory guidance.
  • Ensures LOD processing is accomplished for each IDES case.
  • Provides guidance to all ranks of military personnel from all branches of the uniformed services, retirees, and families of those being processed through the IDES program of their rights, benefits, privileges, or obligations. Effective interpersonal communication skills to effectively accomplish the IDES process.
  • Coordinates evaluation appointments; schedules follow-up appointments and appropriate referrals related to benefits.
  • When the Service member is incapacitated or incompetent for pay purposes and unable to manage his/her own legal affairs, the PEBLO provides guidance and assists the legal next-of-kin on the Service member's rights and benefits
  • Serves as a liaison between the Service member, their respective commander and a multi-disciplinary team of primary care managers, other appropriate health care professionals, medical care case managers, non-medical case managers (e.g., Recovery Care Coordinators (RCC)), patient administration personnel, the Office of the Airmen's Counsel (OAC), the PEB and the Military Department Wounded Warrior Program liaison or advocate. Skill in applying fact finding, analytical, and problem solving methods and techniques.
  • Processes Review-in-Lieu-of (RILO) MEB cases for assignment limitation codes as directed or required by AFPC/DPANM and in accordance with established AF guidance.
  • Receives and responds to inquiries from beneficiaries, DoD Components, other agencies, and various interested parties.
  • Provides guidance on activities with appropriate points of contact throughout the Military Health System (MHS), the line of the Air Force agencies, (i.e. Military Personnel Flights, Comptroller, Air Force Personnel Center (AFPC), Transportation, Aeromedical Evacuation) and the Department of Veterans Affairs (i.e. Veterans Benefits Administration [VBA] and Veterans Health Administration [VHA]) to best meet the member's needs for information or assistance.
  • Assists in preparing appeals, impartial medical reviews, rebuttals, and coordinates the assignment of Service member's legal counsel.
  • Updates local program documentation, i.e., patient handouts, training documents, checklists, operating procedures, etc.
  • Maintains and safeguards both hard copy and electronic medical information.
  • Discloses medical information to authorized personnel in accordance with Privacy Act of 1974 and Health Insurance Portability and Accountability Act (HIPAA) guidelines.
  • Assists the medical professional staff and other staff members on the regulatory and procedural aspects of profiling and disability processing. Provides MEB orientation program and on the job training for assigned staff personnel as required.
  • Tracks all assigned cases, analyzes performance against established standards.
  • Monitors/updates cases in VTA or other tracking tool as the case progresses through the IDES process.
  • Provides reports, briefings, training and respond to inquiries from senior leaders.
  • Coordinates patient travel for members opting to appeal to the FPEB. Assures necessary arrangements are made for members to travel on temporary duty status to and from other locations as required.
  • Initiates actions to facilitate Emergency Family Member Travel for Very Seriously Ill and Injured Service members.
  • Advises service member and medical staff on PEB findings.
  • Assists in preparing appeals and rebuttals and coordinates the assignment of legal counsel.
Education and Experience
  • Associate Degree in business administration, management or health care organizations from an accredited college or university
Two years' experience as a PEBLO within the DoD military health system in the last 6 years; or five years' experience working in a civilian disability program; or two years' experience as a VA Medical Service Coordinator (MSC). Experience requirement could be waived for a candidate with two years of experience in the medical field upon approval from the 19MDG Lead PEBLO.

Additional Eligibility Qualifications
  • The contractor shall use the Disability Counseling Guide for Physical Evaluation Board (PEB) Liaison Officers (PEBLO) as guidance for administrative support.
  • The Government will provide basic military health care principles and practices, PEBLO, MEB, TDRL and DES training.
  • The Government will provide training for various information systems (i.e., Veteran's Tracking Application (VTA), Disability Evaluation System-Information Technology Initiative (DES-ITI), Computerized Informatics Branch (CIB) and Defense Travel System (DTS)). Preliminary training and access will be provided by the Government during the in-processing activities. After completion of the training, the individual will be required to independently use the Government computer system. Competency is at the sole discretion of the Government.
Benefits
  • Medical, Dental and Vision through Carefirst BCBS
  • 401K plan with employer match
  • Paid Holidays
  • Up to 56 hours of Paid Sick Leave
  • Vacation leave
  • Telehealth plan
  • Working Advantage discount purchase plan
  • Balanceworks - Employee Assistance Program

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