This is a permanent position in the Civil Fraud Section, which pursues health care fraud cases under the False Claims Act. These positions will support a significant expansion of the data, research, and analytics team in the Fraud Section. They require clinical, public health, and coding expertise to advise the data team and attorneys of the most likely potential fraud areas based on observable data patterns in light of the incumbent's medical expertise.

Duties

The duties and responsibilities for a GS-0601-15 Medical Advisor generally include, but are not limited to, the following: Providing expert advice of relevant medicine, public health, and health care financing programs (with special emphasis on Medicare), coding, and methods to prevent and detect fraud and abuse. Locating and reviewing medical literature and other medical and pharmacological information. Reviewing information provided to Department staff on case matters by defendants and others to corroborate the accuracy of any medical content included. Reviewing and analyzing medical records and presenting findings, either orally or in written reports. Providing medical representation for the Department of Justice at meetings relevant to health care fraud, as requested by management. Preparing oral and written presentations on medical and program policy issues as requested. Providing guidance to Department attorneys and staff in connection with Medicare and Medicaid billing codes. Recommending and proposing investigative steps or focus areas based upon review, from medical, clinical, or payor policy perspective, of health care data analysis. Preparing written recommendations and proposals with detailed rationale drawing on review of data analysis conducted by Civil Division, and distilling medical, clinical, and payor policy expertise into proposals. As the federal agency whose mission is to ensure the fair and impartial administration of justice for all Americans, the Department of Justice is committed to fostering a diverse and inclusive work environment. To build and retain a workforce that reflects the diverse experiences and perspectives of the American people, we welcome applicants from the many communities, identities, races, ethnicities, backgrounds, abilities, religions, and cultures of the United States who share our commitment to public service.

Requirements

• You must be a United States Citizen or National.
• You will be required to complete a pre-employment security investigation and background check which includes a drug screening.
• You may be required to complete a one-year probationary period.
• Selective Service registration is required for males born on, or after, December 31st 1959. Those not registered should have an approved exemption on file.
• You must meet all eligibility requirements by the closing date of this announcement and continue to meet these requirements throughout the hiring process. Offers can be rescinded if requirements are not met.

Qualifications

To qualify for the position of Medical Advisor, (GS-0601-15), you must meet the basic qualification requirements listed below AND possess the required specialized experience specific to the series and grade you are applying to. Candidates must possess the following basic requirements to receive consideration for this position:1) A Bachelor's or graduate/higher level degree: major study in an academic field related to the medical field, health sciences or allied sciences appropriate to the work of the position. In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. To qualify for the GS-15 position, you must have at least one full year of specialized experience equivalent to the GS-14 level in the Federal service assisting in health care fraud prevention, detection, and enforcement by providing advisement on relevant medicine, coding, public health, and health care financing programs. Conducting coding assessment and/or reviews of clinical procedures. Conducting assessment, research, or advisement on Medicare coverage requirements. Advising on Medicare policies and/or whether certain items or services are rendered consistent with those requirements/policies. Providing medical guidance and technical support in conceiving and conducting health care fraud investigations and enforcement actions. Analyzing medical, clinical, or health care claims data. Conducting medical, clinical, or coding research to provide advice to investigative teams conduct reviews of medical records and presents the findings. You MUST meet all qualification requirements by the closing date of this announcement, 12/10/2024. Your resume must support your responses to the questionnaire and qualification requirements. Failure to do so may result in an ineligible rating. See the Required Documents section for important notes about what must be included in your resume.

Education

This position has a basic education requirement consisting of a Bachelor's or graduate/higher level degree in a major academic field or study related to the medical field, health sciences or allied sciences appropriate to the work of the position.

Education must be reviewed and certified by an accrediting institution recognized by the U.S. Department of Education in order for it to be creditable toward your qualifications. Therefore, you should provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

Foreign Education: If you are using education completed in foreign colleges or universities to meet the qualification requirements, you must show that the education credentials have been evaluated by a private organization that specializes in interpretation of foreign education programs and such education has been deemed equivalent to that gained in an accredited U.S. education program; or full credit has been given for the courses at a U.S. accredited college or university.For more information about this requirement, please visit the U.S. Department of Education website for Foreign Education Evaluation.

All documentation must be in English or include an English translation.

Contacts

• Address Civil Division 1100 L Street, NW Washington, DC 20530 US
• Name: Brandon Cox
• Phone: 202-598-9544
• Email: [email protected]