This position is located in the Department of Labor, Office of Workers' Compensation Programs, Division of Administrative Operations, Branch of Medical and Pharmaceutical Operations which provides medical opinions, technical advice, and assistance with medical and pharmaceutical claims, establishes medical and pharmaceutical standards, adapts medical policy to a OWCP Medical Bill Processing and Pharmacy Benefits Manager systems; and monitors bill processing/benefit payments.

Duties

This position is outside the bargaining unit. For 0301-15: Provide oversight and direction regarding the development, implementation, and operation of the Office of Workers Compensation Programs (OWCP) medical bill processing/provider network operations, and related functions and activities (e.g., claimant and provider inquiries, provider outreach, and fiscal operations). Supervise a staff of Federal professional employees and oversee large, complex bill process operations acquired through contracted services. Provides oversight, and advice that requires exceptional coordination and integration of a number of complex program segments for professional technical, or administrative work. Serve as a senior advisor by providing sound counsel and authoritative recommendations to the Branch Chief, Division Director, Deputy Director, and other senior officials regarding medical bill processing/provider network operations. In this capacity, the incumbent functions as the Project Manager (PM) with overall responsibility for managing broad and highly complex projects and employs strategic planning methods and technical advisory services through discussion of overall and specific problems, which may be precedent-setting, extremely involved, or very unusual, with senior executives and program managers. Function as the Project Manager (PM) or designate and oversee the PM with overall responsibility for managing broad and highly complex projects and employs strategic planning methods and technical advisory services through discussion of overall and specific problems, which may be precedent-setting, extremely involved, or very unusual, with senior executives and program managers. Oversee customer experience (CX) efforts that include medical bill processing, provider network and pharmacy benefits management perspectives. Ensure medical bill processing services are provided in accordance with industry standard approaches, in a professional, respectful, and compassionate manner that ensures equitable access to services for all claimants. Apply mastery project management skills to effectively develop, schedule, coordinate, and administer projects and resources to include monitoring and inspecting costs, work, and contractor performance. Define and establish project scope, requirements, and deliverables as well as short- and long-term system objectives. Consults with physicians, pharmacists and nurses, in determining new or revised policy and procedural guidance for effective medical system operations.

Requirements

• Must be at least 16 years old.
• Must be a U.S. Citizen.
• Candidate required to obtain the necessary security/investigation level.
• Requires a probationary period if the requirement has not been met.
• Subject to financial disclosure requirements.
• Requires a supervisory probationary period if the requirement has not been met. Requires a valid driver's license.

Qualifications

You must meet the Basic Requirements listed in the Education Requirements section and the Specialized Experience to qualify for Supervisory Medical Benefits Systems Officer, as described below. For : Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level GS-14 in the Federal Service. Specialized Experience is the experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform the duties of the position successfully, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level. Qualifying specialized experience for the Gs-15 includes: 1. Overseeing contractors that have experience with medical bill processing operations and system functions; AND 2. Overseeing the planning, development and implementation of medical bill processing/provider network changes, improvements, and modernization initiatives; AND 3. Managing a staff who work remote and nationwide.

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 coursework requirements for this position. Click Evaluation of Foreign Education for more information.

Contacts

• Address Office of Workers Compensation Programs 200 Constitution Avenue NW Washington, DC 20210 US
• Name: Kevin Heldeffer
• Phone: 215-446-3722
• Email: [email protected]