Program Analyst

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 07/01/2026. Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-11 position you must have served 52 weeks at the GS-09. For a GS-12 position you must have served 52 weeks at the GS-11.The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment. You may qualify for GS-11 based on your experience and/or education as described below: GS-11 Specialized Experience: Possess one year of specialized experience equivalent to at least the next lower grade (GS-09) in the normal line of progression for the occupation in the organization. In order to meet the minimum qualifications for this position, you must meet 3/5 of the following examples of specialized experience: Examples of specialized experience would typically include, but are not limited to: Deliver communication & educational material to private sector healthcare providers on topics related to Veterans benefits, healthcare referrals, urgent care and submitting claims for payment. Experience in healthcare claims processing operations, including authorization and eligibility determination, provider relations, reimbursement methodologies and coordination of benefits. Analysis of claims management data and automated processing systems. Experience applying qualitative and quantitative analytical methods to evaluate and improve program effectiveness and operational efficiency. Prepare comprehensive reports, briefings, and other written products to support management decision-making and program oversight. OR, GS-11 Education: Applicants may substitute education for the required experience. Possess a Ph.D. or equivalent doctoral degree which related to the work of the position or 3 full years of progressively higher-level graduate education leading to such a degree. (TRANSCRIPTS ARE REQUIRED) OR, GS-11 Combination of Education and Experience: Possess a combination of specialized experience and graduate education to meet the total qualification requirements for this position. Only graduate education in excess of a master's or equivalent graduate degree (two years graduate education) which related to the work of the position may be used to qualify at this level. (TRANSCRIPTS ARE REQUIRED) You qualify for GS-12 based on your experience as described below: GS-12 Specialized Experience: Possess one year of specialized experience equivalent to at least the next lower grade (GS-11) in the normal line of progression for the occupation in the organization. In order to meet the minimum qualifications for this position, you must meet 4/5 of the following examples of specialized experience: Examples of specialized experience would typically include, but are not limited to: Deliver communication & educational material to private sector healthcare providers on topics related to Veterans benefits, healthcare referrals, urgent care and submitting claims for payment. Experience in healthcare claims processing operations, including authorization and eligibility determination, provider relations, reimbursement methodologies and coordination of benefits. Analysis of claims management data and automated processing systems. Experience applying qualitative and quantitative analytical methods to evaluate and improve program effectiveness and operational efficiency. Prepare comprehensive reports, briefings, and other written products to support management decision-making and program oversight. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.

Prioritizes escalated provider issues related to unpaid claims for services provided and coordinates with Agency regional healthcare networks (i.e., Veterans Integrated Service Networks) and medical centers and contractors to resolve them. Monitors appeals from providers within assigned geographic areas and provides support to the local Agency medical centers or third-party administrator as needed to ensure providers' issues are addressed. Communicates issues to stakeholders and helps create action plans to improve quality metrics and maintains contact with stakeholders throughout the appeal process. Communicates and negotiates with internal and external stakeholders to accept and implement recommendations involving resources, required changes in established procedures, and impacts to the stakeholder; independently produces reports and documents per management's request Conducts data analyses, data validations, and program analyses to assess the efficiency and effectiveness of processes in place at field facility associated with the Program Office's operations Analyzes trends for a range of initiatives (e.g., network adequacy, provider complaints, credentialing compliance) compared across Program Office geographic regions on a national level, identifying areas where deficiencies or irregularities that may need further review, research, and/or analysis to determine anomalies between sites Quantitatively and qualitatively analyzes and evaluates the effectiveness of wider employing office operations in meeting established goals and objectives. Drafts responses to external inquiries and develops issue briefs, routing to appropriate management/staff as required. Makes formal and informal presentations outlining the history, current status, and objectives of analyses and quality improvement functional responsibilities. Develops training content and associated presentation material to educate/inform Program Office partners (e.g., contractors, Agency field staff) on Program Office operations, policies, and processes related to provider network management administration. Administers and integrates the work of assigned project team members from different organizations for assigned projects to include scheduling, tracking progress, providing project and task status updates to project team members and management, and adhering to due dates and other requirements. Develops strategies that include considerations of current program operations, associated systems, and future initiatives Other duties as assigned. 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. Work Schedule: Mon- Fri, 8 hours a day based on business needs Compressed/Flexible: No. Telework: Telework eligibility will be discussed during the interview process. Virtual: This position may be authorized for Virtual Work. Virtual Work eligibility is for current VA employees that are already subject to the return to the in-person work mandate in their current position. Definition of Virtual Work: Employee works outside of original hiring duty station at a VA-owned or leased space. Return to Office (RTO): RTO mandates are in effect and selectees will be required to report to in-person work unless they are approved for an exception or an exemption. Any approval for an RTO exception, exemption, or extension will happen after a tentative job offer, but before a final job offer. Position Description/PD#: Program Analyst/PD05098A and PD56770A Relocation/Recruitment Incentives: Not authorized. Critical Skills Incentive (CSI): Not approved. Permanent Change of Station (PCS): Not authorized.