Beneficiary Services Representative

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Beneficiary Services Representative (PEBLO) BENEFICIARY SERVICES REPRESENTATIVE (PEBLO) SUMMARY. 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. 1. QUALIFICATIONS: 1.1. Mandatory knowledge and skills. 1.1.1. 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. 1.1.2. Possess in-depth knowledge, experience, and training to handle and solve complex cases that arise when addressing fitness for duty or physical disability evaluation issues. 1.1.3. Demonstrate tact, diplomacy, and restraint in counseling and explaining entitlements, benefits, and responsibilities to all customers. 1.1.4. Possess effective interpersonal communication skills to effectively accomplish the IDES process Demonstrate mastery of oral and written communication and customer service principles, methods, practices, and techniques analytic methods, to include using 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. 1.2.1. Ability to gather data from various sources, analyze data, statistical analysis, prepare statistical reports and recommendations for improvements. 1.2.2. Skill in applying fact finding, analytical, and problem-solving methods and techniques. 1.2.3. Knowledge of DES processing regulations, instructions, procedures, and policies to assure timely case processing. 1.2.4. Practical knowledge and understanding of the TRICARE program. 2.1. Education. Associate Degree in business administration, management or health care organizations from an accredited college or university. 2.2. Experience. 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). 2.3. Work Environment/Physical Requirements. The work is primarily sedentary. Requirements include prolonged walking, standing, sitting or bending. 2.1. The IDES support team will provide ongoing IDES training guidance. 2.2. PEBLO training will include: Orientation training, on-the-job training, standardized DES annual refresher or continuing education and training to ensure PEBLOs remain current in their understanding and application of DES procedures. Training will be accomplished via computer-based training, monthly DCS teleconference, and ongoing email communications. May be required to travel for IDES training workshop at the Government’s discretion every two years; travel and reimbursement is in accordance with task order requirements. 2.2. Training will be in accordance with Warrior Care Policy Training Standards and Performance Objectives Guidebook. 2.3. Veteran Tracking Application training will be provided by the Veterans Benefits Administration (VBA/DoD Collaboration Team) via DCS training. 2.4. Regulatory Guidance: DoDM 1332.18 Vol 1, Disability Evaluation System (DES) Manual: General Information and Legacy Disability Evaluation System (LDES) Time Standards, Enclosure 5, DoDM 1332.18, Vol 2, Disability Evaluation System (DES) Manual: Integrated Disability Evaluation System (IDES), Enclosure 4 and service-specific regulations, TRICARE Operations and Patient Administration Functions, Section 4K – Medical Evaluation of Service Members (SM) for Continued Military Service. 3. PERFORMANCE OUTCOMES: 3.1. Responsible for obtaining, assembling, and forwarding all required documents and records to required organizations as well as the Veteran Affairs Medical Service Coordinator, the local MEB, the IPEB, the FPEB and other IDES stakeholders in accordance with regulatory guidance. 3.1.1. Ensures LOD processing is accomplished for each IDES case. 3.2. 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. 3.3. Coordinates evaluation appointments: schedules follow-up appointments and appropriate referrals related to benefits. 3.4. 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. 3.5. 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 service-specific offices, the PEB and the Military Department Wounded Warrior Program liaison or advocate. 3.4.1. Processes Review-in-Lieu-of (RILO) MEB cases for assignment limitation codes as directed or required by regulation and in accordance with established guidance. 3.5. Receives and responds to inquiries from beneficiaries, DoD Components, other agencies, and various interested parties. 3.6. Provides guidance on activities with appropriate points of contact throughout the Military Health System (MHS), the line of the service agencies, (i.e. Military Personnel Flights, Comptroller, military Personnel Centers, 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. 3.7. Assists in preparing appeals, impartial medical reviews, rebuttals, and coordinates the assignment of Service member’s legal counsel. 3.8. Updates local program documentation, i.e., patient handouts, training documents, checklists, operating procedures, etc. 3.9. Maintains and safeguards both hard copy and electronic medical information. 3.9.1 Discloses medical information to authorized personnel in accordance with Privacy Act of 1974 and Health Insurance Portability and Accountability Act (HIPAA) guidelines. 3.10. 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. 3.11. Tracks all assigned cases, analyzes performance against established standards. 3.11.1. Monitors/updates cases in VTA or other tracking tool as the case progresses through the IDES process. 3.12. Analyzes available data using various statistical analytic tools, measuring means, trends, statistical deviations, constructs diagrams, histograms, charts, etc., to convey IDES performance to IDES stakeholders. 3.12.1 Provides reports, briefings, training and respond to inquiries from senior leaders. 3.13. 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. 3.14. Initiates actions to facilitate Emergency Family Member Travel for Very Seriously Ill and Injured Service members. 3.15. Advises service member and medical staff on PEB findings. 3.16. Assists in preparing appeals and rebuttals and coordinates the assignment of legal counsel. 3.17. Initiates actions to facilitate Emergency Family Member Travel for Very Seriously Ill and Injured Service members. 3.18. Advises service member and medical staff on PEB findings. 3.19. Assists in preparing appeals and rebuttals and coordinates the assignment of legal counsel. Serves as a liaison between the Service member, their respective commander and a multidisciplinary team of primary care managers, other appropriate health care professionals, medical care case managers, non-medical case managers (e.g., Recovery Care Coordinators (RCC)), Office of Disability Counsel (ODC), patient administration personnel, the service-specific offices, the PEB and the Military Department Wounded Warrior Program liaison or advocate. Patient Sensitivity. Contractor personnel shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity. 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.

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