Health Systems Specialist (Compliance & Business Integrity Officer)
Duties and responsibilities include, but are not limited to:
Investigates compliance exceptions and other violation containing elements of fraud, waste, and abuse. Analyzes performance and workload data; and ensures full compliance with Medicare (CMS) guidelines, The Joint Commission (TJC) standards, VA directives, and other related regulatory requirements. Performs assigned tasks/programs in accordance with the professional criteria for gathering, analyzing, and evaluating information; preparing fact-finding studies concerning business processes; and making recommendations for compliance process improvement. Provides leadership with written reports specifying recommendations in clinical documentation and administrative process improvements. Coordinates efforts to communicate compliance related information which addresses identified compliance risk area; e.g. results from consultant reviews/internal review, to those operational areas that would be impacted by any revisions to current processes and procedures. Assist in developing, implementing and maintaining the Compliance Program throughout the Healthcare System. Creates a communications process and tools that are flexible, customizable and interactive to address the medical facilities unique compliance challenges and education/training needs. Ensures a mechanism is utilized for documenting and tracking operational area compliance training and monitors this mechanism to ensure system is used and information is captures timely. Monitor the responses received from Compliance Line regarding allegations of improper/illegal activities and the enforcement of appropriate disciplinary action against employees who have violated internal compliance policies, regulations, or federal healthcare program. Use audits and/or other evaluation techniques to monitor compliance and to assist in the reduction of identified problem areas. Work Schedule:
Monday through Friday, 8:
00 am - 4:
30 pm Telework:
Not Available Virtual:
This is not a virtual position. Position Description/PD#:
Health Systems Specialist (Compliance & Business Integrity Officer)/PD573-4649-A Relocation/Recruitment Incentives:
Recruitment incentive may be authorized for highly qualified candidate Financial Disclosure Report:
Not required To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 08/28/2020. 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-13 position you must have served 52 weeks at the GS-12. 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. You may qualify based on your experience as described below:
Specialized
Experience:
You must have one year of specialized experience equivalent to at least the next lower grade GS-12 in the normal line of progression for the occupation in the organization. Qualifying specialized experienceis defined as:
Knowledge of organization and structure of healthcare delivery systems or managed care networks. Initiate, develop, draft and interpret written Medical Center policies and procedures. Knowledge of laws and regulations governing business practices, health industry standards, and Fee Basis care business practices. Possesses a wide range of analytical and auditing skills. Knowledge of computer programs such as Vista, Internet Explorer, Excel, Word, Access, PowerPoint, Publisher, Visio, Lync, Outlook, SharePoint, ProClarity, Compliance Incident Reporting & Tracking System (CIRTS). Provides guidance to senior management, Compliance Committee, and Medical Center Staff. Monitor and audit processes and appropriate business practices. Develop job-specific training related to CBI and trains employees annually. You will be rated on the following Competencies for this position:
AuditingBusiness Process ReengineeringCompliance InspectionCreative ThinkingCustomer ServiceDecision MakingEducation and TrainingRisk Management Experience 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:
The work is sedentary in nature. Typically, the incumbent will sit to perform work functions, but there will be some walking, standing, reaching, stooping, bending, kneeling, crouching or carrying light items. 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/.
Estimated Salary: $20 to $28 per hour based on qualifications.
Investigates compliance exceptions and other violation containing elements of fraud, waste, and abuse. Analyzes performance and workload data; and ensures full compliance with Medicare (CMS) guidelines, The Joint Commission (TJC) standards, VA directives, and other related regulatory requirements. Performs assigned tasks/programs in accordance with the professional criteria for gathering, analyzing, and evaluating information; preparing fact-finding studies concerning business processes; and making recommendations for compliance process improvement. Provides leadership with written reports specifying recommendations in clinical documentation and administrative process improvements. Coordinates efforts to communicate compliance related information which addresses identified compliance risk area; e.g. results from consultant reviews/internal review, to those operational areas that would be impacted by any revisions to current processes and procedures. Assist in developing, implementing and maintaining the Compliance Program throughout the Healthcare System. Creates a communications process and tools that are flexible, customizable and interactive to address the medical facilities unique compliance challenges and education/training needs. Ensures a mechanism is utilized for documenting and tracking operational area compliance training and monitors this mechanism to ensure system is used and information is captures timely. Monitor the responses received from Compliance Line regarding allegations of improper/illegal activities and the enforcement of appropriate disciplinary action against employees who have violated internal compliance policies, regulations, or federal healthcare program. Use audits and/or other evaluation techniques to monitor compliance and to assist in the reduction of identified problem areas. Work Schedule:
Monday through Friday, 8:
00 am - 4:
30 pm Telework:
Not Available Virtual:
This is not a virtual position. Position Description/PD#:
Health Systems Specialist (Compliance & Business Integrity Officer)/PD573-4649-A Relocation/Recruitment Incentives:
Recruitment incentive may be authorized for highly qualified candidate Financial Disclosure Report:
Not required To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 08/28/2020. 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-13 position you must have served 52 weeks at the GS-12. 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. You may qualify based on your experience as described below:
Specialized
Experience:
You must have one year of specialized experience equivalent to at least the next lower grade GS-12 in the normal line of progression for the occupation in the organization. Qualifying specialized experienceis defined as:
Knowledge of organization and structure of healthcare delivery systems or managed care networks. Initiate, develop, draft and interpret written Medical Center policies and procedures. Knowledge of laws and regulations governing business practices, health industry standards, and Fee Basis care business practices. Possesses a wide range of analytical and auditing skills. Knowledge of computer programs such as Vista, Internet Explorer, Excel, Word, Access, PowerPoint, Publisher, Visio, Lync, Outlook, SharePoint, ProClarity, Compliance Incident Reporting & Tracking System (CIRTS). Provides guidance to senior management, Compliance Committee, and Medical Center Staff. Monitor and audit processes and appropriate business practices. Develop job-specific training related to CBI and trains employees annually. You will be rated on the following Competencies for this position:
AuditingBusiness Process ReengineeringCompliance InspectionCreative ThinkingCustomer ServiceDecision MakingEducation and TrainingRisk Management Experience 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:
The work is sedentary in nature. Typically, the incumbent will sit to perform work functions, but there will be some walking, standing, reaching, stooping, bending, kneeling, crouching or carrying light items. 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/.
- Department:
0671 Health System Specialist - Salary Range:
$91,231 to $118,603 per year
Estimated Salary: $20 to $28 per hour based on qualifications.
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