This position is assigned to the Office of the Director, Command Suite, located at the Captain James A. Lovell Federal Health Care Center (FHCC), North Chicago, Illinois; complexity facility. The Lovell FHCC is larger than just a single facility, but rather a system of facilities throughout Northeastern Illinois and Wisconsin which provide medical and dental services to U.S. Military Veterans, Recruits, and Active Duty and eligible beneficiaries. This position is open to facility only

Duties

MAJOR DUTIES Auditing (70%) Performs functions associated with the initial and continued development and oversight of the facility Integrity and Compliance Program. Elements of the facility Integrity and Compliance Program include, but are not limited to, preventing illegal and/or unethical conduct; responding to alleged violations of law, rule, or regulation; reporting alleged violations to appropriate existing channels for investigations and resolution; planning program objectives; and developing risk management solutions and associated mitigation plans, such as, monitoring and auditing, and creating training and education plans. Collaborates with the facility Integrity and Compliance Officer (ICO) in planning, developing, and implementing programs to effectively identify, plan, assess, respond, and monitor areas of high risk, and coordinate efforts to improve performance as deemed necessary while performing VHA and other mandated audits and reviews of compliance program areas. These areas include: insurance identification and verification; enrollment; eligibility; utilization review; precertification/ certification; billing, coding, documentation; audits, reviews, inquiries, and remediation; accounts receivable and payable; HHS OIG exclusionary list; information protection, record retention, managing requests for information; provider documentation; staff education/training in compliance; management of the Integrity and Compliance Helpline and database tracking system; overpayments; questionable conduct on the part of management, supervisors, or employees, Non-VA Medical Care and any other matter relating to the business integrity of VHA operations. Performs quality review audits on these areas to ensure that the facility business operations are accurate, reliable, and will also perform in depth reviews and audits of perceived problem areas discovered during routine monitoring programs. Provides evaluation of documentation of medical services provided by VA physicians, nurse practitioners, physician assistants, social workers, and other health care professionals and to ensure that all services documented are in compliance with established guidelines, including Medicare guidelines for reimbursement, VA regulations, and Joint Commission standards. Compliance Program Operation Duties (20%) Provides educational assistance to facility staff under the direction of the Integrity and Compliance Officer. This includes: Determining compliance educational requirements of health care providers and other employees; Gathering data to assist in the educational process, including resources from Medicare, VA regulations, and private sources; Gathering data to assist providers including analysis of current documentation; Gathering data to assist providers in customizing and streamlining current documentation, including the encounter form, templates, and forms; Providing assistance to the ICO in presentations, workshops, and conference calls for educational and other purposes. Program Support (10%) Compiles and maintains appropriate management reports and committee minutes; Assists in maintaining good communications between the OIC Office and VA staff; Provides technical assistance to the ICO in the selection of focused audits, criteria development, data retrieval, compilation of findings, and follow-up audits oriented toward improved utilization of resources including cost effectiveness; Continues education to keep abreast of new developments and policy changes that affect the Integrity and Compliance Program and recommends revisions of the technical aspects of these programs to meet these new demands. Provides staff support to the Integrity and Compliance Committee. Participates in discussions, develops agenda content for recurring meetings and prepares meeting minutes. Creates communication processes and tools that are flexible, customizable, and interactive to address the health care system's unique compliance challenges and education/training needs. Work Schedule: Monday-Friday 7:00am -3:30pm Telework: VA supports the use of telework as a way to help attract and retain talented individuals in public service, increase worker productivity, and better prepare the agency to operate during emergencies. This position may be authorized for telework. Telework eligibility will be discussed during the interview process.

Requirements

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 11/12/2024. 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-09 position you must have served 52 weeks at the GS-07. 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 based on your experience and/or education as described below: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-07 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Progressively responsible analytical or administrative, or clinical management or supervisory experience in the health care field. This work may have been performed in an operating health care facility or a higher organizational echelon with advisory or directional authority over such facilities. Work must have involved a close working relationship with facility managers and analysis and/or coordination of administrative, clinical, or other service activities, and provided knowledge of the following: Missions, organizations, programs, and requirements of health care delivery systems; Regulations and standards of various regulatory and credentialing groups; and Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement. OR, Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have be in one of the: GS-09 Grade Level:Major study -- hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related OR, 1 year equivalent to at least GS-7 to be eligible for GS-09. GS-11 Grade Level: Major study -- hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. Ph.D. or equivalent doctoral degree or 3 full years of progressively higher level graduate education leading to such a degree or LL.M., if related . OR, 1 year equivalent to at least GS-9 to be eligible for the GS-11. Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education beyond .You will be rated on the following Competencies for this position:Interpersonal SkillsNegotiationPlanning and EvaluatingProject ManagementReasoningTechnical CompetenceExperience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Note: A full year of work is considered to be 35-40 hours of work per week. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. Physical Requirements: 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/.

Education

IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education.

Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

Contacts

• Address Captain James A Lovell Federal Health Care Center 3001 Green Bay Road North Chicago, IL 60064 US
• Name: Brianna Turner
• Phone: 708-904-8377
• Email: [email protected]