This position is located in District Office of Division of Federal Employees' Compensation (DFEC). The office is responsible for administrating Federal Employees' Compensation Act (FECA) and related laws for job-related injuries/deaths sustained by Federal employees and others eligible for benefits under FECA; also responsible for the accurate and timely adjudication/management of claims and payment of benefits, including those medical services rendered for work-related conditions.
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Ensures medical bill payments are appropriate for the accepted conditions of the injured worker and are in accordance with DFEC policies.
Provides technical expertise for claims examiners and management on coding accepted conditions for injured workers.
Receives, monitors, communicates, intervenes and responds to district office inquires and concerns for which further actions by the contact bill processor and/or DOL are required.
Conducts training for District Office staff on medical coding and treatment suites in layman's terms, as well as training for Federal agencies, healthcare providers to improve their understanding of the bill processing system.
Responsible for spotting trends of systemic problems and conducting analysis to resolve and correct any negative elements of the bill payment, treatment suite and medical authorization process.
Evaluates and reports unresolved and new policy issues to the National Office (following District Office protocol) for appropriate action.
Independently decides all fee schedule appeals resulting from the application of the OWCP fee schedules or other cost containment initiatives.
Participates in accountability reviews of District Offices as the subject matter expert on medical coding aspects of the reviews.
Monitors high cost medical payments to ensure their accuracy and appropriateness, and to identify potential instances of over-utilization, fraud and/or abuse.
11 - Position is announced at full performance level.
Job family (Series)
0301 Miscellaneous Administration And Program
HelpRequirements Conditions of Employment
Requires a probationary period if the requirement has not been met.
Appointment to this position may require a background investigation.
Applicants must meet all legal and regulatory requirements. Reference the "Required Documents" section for additional requirements.
Applicant must have 52 weeks of Specialized Experience equivalent to at least the next lower grade level, GS-09, in the Federal Services. Specialized Experience is defined as experience that equipped the applicant with the particular knowledge, skills, and abilities to perform successfully the duties of the position, and that is typically in or related to medical coding.
Specialized Experience for this position:
Experience with health care billing and coding practices, coding systems for medical services, health care delivery systems, and medical bill processing systems;
Experience in fact finding, analysis, problem solving, and evaluating coding matters and other health care issues in order to make decisions on suspended bills, instances of potential abuse and fee schedule appeals;
Experience applying analytical and evaluative methods and techniques to analyze the processes and procedures of the various systems that contribute information regarding bill payment, medical treatment, payment of benefits and medical authorizations in order to detect trends of systematic problems and recommend methods or revised procedures that will increase efficiency and control costs.
Or you may substitute education for specialized experience as follows:
PH.D. or equivalent doctoral degree;
3 full years of progressively higher level graduate education leading to such a degree;
LL.M., if related;
Equivalent combinations of education and experience.
College Transcript and Evaluation of Foreign Education - The Department of Labor does not recognize academic degrees from unauthorized secondary schools or post-secondary institutions that are not accredited by an accrediting body recognized by the Department of Education. Any applicant falsely claiming an academic degree from an accredited school will be subject to actions ranging from disqualification from federal employment to removal from federal service. If your education was completed at a foreign college or university, you must show comparability to education received in accredited educational institutions in the United States and comparability to applicable minimum course work requirements for this position. Click Evaluation of Foreign Education for more information.
Department Of Labor