DOL seeks to attract and retain a high performing and diverse workforce in which employees' differences are respected and valued to better meet the varying needs of the diverse customers we serve. DOL fosters a diverse and inclusive work environment that promotes collaboration, flexibility and fairness so that all individuals are able to participate and contribute to their full potential.
This position is located in the U.S. Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP), Division of Energy Employees Occupational Illness Compensation (DEEOIC), Branch of Medical Benefits Adjudication and Bill Processing, Medical Bill Processing Unit (MBPU). The mission of DEEOIC is developing, establishing and implementing policies, regulations and procedures necessary for the administration of benefit provisions of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) of 2000 (public Law 106-398) as mandated by Executive Order 13179 dated December 7, 2000.
There is 1 vacancy and the position can be filled in any of the following locations:
This position is at the Full-performance level GS-13. There is no obligation to provide future promotions to you if you are selected. Additional vacancies maybe filled using this announcement. Incumbent will be required to obtain the appropriate investigative/security level required.
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This position is responsible for conducting ongoing analysis and review of all aspects of the Branch's program Medical Bill and Home Health Care auditing functions by independently reviewing the full range of complex data submitted and/or obtained and to provide the program with information to make informed decisions concerning program integrity, objectives, and the prevention and detection of fraud, risk, and abuse.
Performs research, analysis, assessments, and related activities required to effectively establish and maintain audit requirements, processes and procedures to ensure Central Bill Processing contractor adherence to DEEOIC medical bill policies and procedures and practices. Coordinate the medical bill sample collection utilizing unique random and/or targeted methodologies or other approaches. Performs research, analysis, assessments, and related activities required to effectively establish and maintain audit requirements, processes and procedures to ensure Central Bill Processing contractor adherence to DEEOIC medical bill policies and procedures and practices. Coordinate the medical bill sample collection utilizing unique random and/or targeted methodologies or other approaches.
Triage allegations of healthcare fraud by medical professionals or other medical facilities (i.e., home health providers) and conducts special analysis, studies of potential fraud cases and defines issues including the anticipation of emerging issues, which are directly related or of interest to DEEOIC or needs to be addressed by the Program, and advises management on the appropriate course of action. Performs quality assurance measures and develops queries and statistical parameters to support pattern recognition that may indicate fraudulent activity. This may include provider and recipient patterns that are inconsistent with sound fiscal, business, or medical practices and which result in unnecessary costs. Drafts audit/investigative reports summarizing evidence, audit activities, and findings. This includes compiling and organizing accurate case file documentation and calculation of overpayments. Prepare written reviews of findings and provide reports to the Branch Chief and Payment Systems Manager for requests/recommendations to the Office of the Inspector General (OIG) for review and further investigation where appropriate.
Prepares and presents materials requested by the DOL OIG. Assist management with any OIG investigation of improper requests for payment and improper payments. Ensure compliance with internal control procedures as it relates to Improper Payments Elimination and Recovery Act (IPERA). Works with the Payment Systems Manager and National Office Fiscal Operations Specialist in communicating repayment actions and recovery strategies. Serves as a subject matter expert regarding audit findings of medical bill processing data.
As required, serves as DEEOIC's representative in meetings with Treasury, GAO and OIG staff. Represents the Branch and Program on task forces and working groups concerned with potential fraud investigations, judicial processes relating to fraud prosecutions. Assists in the development of new audit policies and procedures. Stays abreast of new audit trends and developments with other Programs, Federal Agencies (i.e., CMS), and State and Federal Worker's Compensation Programs. Interprets federal and state laws, legislative mandates, DOL, OWCP, and program policies, standards, and requirements. Provides advice and counseling regarding outreach topics to aide in effective communications to providers and claimants.
Occasional travel - Occasional travel to District locations for the purpose of conducting audits.
Who May ApplyThis job is open to
Current/former Federal employees w/ competitive/reinstatement eligibility; ICTAP/CTAP eligibles in local commuting area; Veterans Employment Opportunity Act eligibles.
Questions? This job is open to 3 groups.
Managers, All Other
HelpRequirements Conditions of Employment
Must be at least 16 years of age.
Requires a probationary period if the requirement has not been met.
Appointment to this position may require a background investigation.
Applicants must meet time-in-grade, time-after-competitive-appointment and qualifications requirements within 30 calendar days after the closing date of the vacancy to be eligible for consideration for selection. Reference the "Required Documents" section for additional requirements.
IN DESCRIBING YOUR EXPERIENCE PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR SPECIALIZED EXPERIENCE.
Applicants must have at least 52 weeks experience at the next lower level in the normal career progression of the position being filled. When compared to Federal experience, this experience must be equivalent to at least the next lower grade level of GS-12. This experience may have been gained either in the Federal or Private sectors, demonstrating experience in conducting continuous analysis and evaluation of Medical Billing and Home Health Care programs in order to measure program integrity; experience utilizing investigative strategies to identify and detect abnormal billing trends and recommend solutions; and experience utilizing communication skills to develop and present audit findings and resolutions to various audiences.
There is no educational substitution for this position.
Department Of Labor