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 within the U.S. Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP), Division of Energy Employees Occupational Illness Compensation Programs (DEEOIC), Medical Bill Processing Unit (MBPU) in Washington, D.C.
The mission of Division is developing, establishing, and implementing policies, regulations and procedures necessary for the administration of benefit provisions of the Energy Employees Occupational Illness Compensation Act (EEOICA), 42 U.S.C. 7384 et seq., as mandated by Executive Order 13179, dated December 7, 2000.
This position has no further promotion potential.
This position is outside the bargaining unit.
Additional vacancies may be filled using this announcement.
Summary
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 within the U.S. Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP), Division of Energy Employees Occupational Illness Compensation Programs (DEEOIC), Medical Bill Processing Unit (MBPU) in Washington, D.C.
The mission of Division is developing, establishing, and implementing policies, regulations and procedures necessary for the administration of benefit provisions of the Energy Employees Occupational Illness Compensation Act (EEOICA), 42 U.S.C. 7384 et seq., as mandated by Executive Order 13179, dated December 7, 2000.
This position has no further promotion potential.
This position is outside the bargaining unit.
Additional vacancies may be filled using this announcement.
If selected for this position, you will be 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. Provide the program with information to make informed decisions concerning program integrity, objective, 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 Division of Energy Employees Occupational Illness Compensation Programs medical bill policies and procedures and practices. Coordinate the medical bill sample collection utilizing unique random and/or targeted methodologies or other approaches.
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.
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 Division of Energy Employees Occupational Illness Compensation Programs or needs to be addressed by the Program, and advises management on the appropriate course of action.
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.
Represents the Branch and Program on task forces and working groups concerned with potential fraud investigations, judicial processes relating to fraud prosecutions.
Appointment to this position may require a background investigation..
Requires a probationary period if the requirement has not been met.
Applicants must meet all legal and regulatory requirements. Reference the "Required Documents" section for additional requirements.
Qualifications
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 a strong knowledge of advanced analytical and evaluative methods and techniques in order to assess the effectiveness of a medical bill processing and payments program. Examples of specialized experience include:
Reviewing and analyzing medical bills to determine whether such bills are being paid or denied in accordance with a federal or state government and/or privately owned healthcare business procedures
Conducting audits and studies of potential fraud cases;
Drafting audit/investigative reports to summarize evidence, audit activities and findings; and/or
Conducting formal and informal meetings and presentations to internal and external contacts.
Education
There is no educational substitution for this position.
Additional information
The United States Government does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.
The Department of Labor does not make unfavorable hiring decisions on the basis of an applicant's previous or current unemployment, or the fact that an applicant has experienced financial difficulty through no fault of his/her own and has undertaken good faith efforts to meet his/her financial obligations. Consideration is given to financial status in relation to appointments only where required by law, regulation, or Executive Order.
A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.
How you will be evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
If you meet the minimum qualifications, you will be evaluated against the evaluation factors below and will be placed into a category based on your vacancy question responses.
Categories
Category A - Meets the basic qualification requirements for the vacancy and has successful experience in the same or similar job that has demonstrated superior proficiency in applying critical competencies required by this position to work of increased levels of difficulty and complexity.
Category B - Meets the basic qualification requirements for the vacancy and demonstrates satisfactory proficiency in the critical competencies required by this position.
Category C - Meets the specialized experience described in the minimum qualifications requirements section of this announcement and demonstrates proficiency in the basic competencies.
Evaluation Factors (Competencies) - All qualified applicants will be evaluated on the following key competencies:
Problem Solving - Identifies problems; determines accuracy and relevance of information; uses sound judgment to generate and evaluate alternatives, and to make recommendations.
Technical Competence -Uses knowledge that is acquired through formal training or extensive on-the-job experience to perform one's job; works with, understands, and evaluates technical information related to the job; advises others on technical issues.
Oral Communication - Expresses information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information (for example, technical, sensitive, controversial); makes clear and convincing oral presentations; listens to others, attends to nonverbal cues, and responds appropriately.
Writing - Recognizes or uses correct English grammar, punctuation, and spelling; communicates information (for example, facts, ideas, or messages) in a succinct and organized manner; produces written information, which may include technical material, that is appropriate for the intended audience.
The information you provide may be verified by a review of your work experience and/or education, by checking references and through other means (ex. interview). The examining Human Resources Office (HRO) makes the final determination concerning applicant ratings. Your resume MUST provide sufficient information to substantiate your responses to the vacancy questions. If not, the HRO may amend your responses to more accurately reflect the level of competency indicated by the content of your resume. Your evaluation may also include a review by a Human Resources Specialist or panel and may include other assessments (ex. interview, panel review, written test, writing sample, etc.)
INFORMATION FOR ICTAP ELIGIBLES ONLY: If you are eligible for special priority selection under ICTAP, you must be well-qualified for the position to receive consideration. ICTAP eligibles who are placed into Category B or higher will be considered "well-qualified".
A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.
The following documents must be submitted by 11:59 p.m. (ET) on the vacancy closing date. Follow the instructions: click How To Submit Supplemental Documentation Document. You are not required to submit a document if it does not apply to you. Warning: If you submit a document using the same document title, the 2nd submission will OVERWRITE the 1st submission. Also, do not upload password protected documents.
- Veterans Documents (if applicable): To be considered as a 5-point preference eligible, you must submit a copy of your Certificate of Release or Discharge From Active Duty, DD214. Your DD-214 must show the type of discharge and dates of active duty. To claim 10-point preference, you must submit a copy of your DD214; an Application for 10-point Veteran's Preference, SF15; and the proof of entitlement of this preference which is normally an official statement, dated 1991 or later, from the Department of Veterans Affairs certifying to the present existence of the service-connected disability and indicating the percentage of your disability. (For active duty service members expecting honorable or general discharge or release within 120 days, click Active Duty). Without this documentation, you will not receive veteran's preference. For more information, go to: http://www.fedshirevets.gov/hire/hrp/vetguide/index.aspx
- Displaced Employee Placement Documents – Only required if requesting priority consideration under CTAP or ICTAP eligibility.
- Cover Letters are not mandatory and will not be used to verify experience, but may be submitted
Applicants selected for employment who are not current DOL employees will be required to provide proof of citizenship, and the E-Verify system will be used to confirm the employment eligibility of all new hires.
If you are relying on your education to meet qualification requirements:
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
Follow the steps below to apply. Your application and ALL required supplemental documents must be received before the job closes – since this job has an application limit of 50, it will close at 11:59 pm Eastern Time (ET) ON THE DATE THIS LIMIT IS REACHED or ON THE VACANCY CLOSING DATE, whichever OCCURS FIRST. If the job closes on the date the limit is reached, applicants will no longer be able to edit their applications. Paper applications and supplemental documents submitted in any other manner without prior approval from the vacancy contact will not be considered.
SAVE your information before the 30 MINUTE TIMEOUT! For help, go to https://www.usajobs.gov/Help/how-to/.
STEP 1 - Create USAJOBS Account on www.usajobs.gov, including Resume and Saved Documents
Your resume must provide sufficient information to substantiate your responses in the self-assessment vacancy questions. If not, HR may amend your responses to more accurately reflect the competency indicated by resume content. FOR EACH EMPLOYMENT PERIOD, include: start/end month & year and note full-time or part-time (if part-time, include # of hours worked per week); otherwise, your application may be considered incomplete.
STEP 2 - Complete the 1st part of the application process (USAJOBS)
Once you have identified a job on www.usajobs.gov that you wish to apply for, click on the title and click the Apply button . For questions about the vacancy, click the “Agency Contact Information” link. Click “Start Application” and proceed through 5 steps noted at the top of the USAJOBS page. You will be able to select a resume and documents from your USAJOBS Account that you can submit as a package as part of your DOL application. At Step 5, click “Continue to Agency Site”.
STEP 3 – Complete the 2nd part of the application process (DOL)
On the Department of Labor (DOL) page, create a DOL Account and click “APPLY TO THIS VACANCY”. Continue through the 7 progress steps noted at the top of the DOL page. The 3rd progress step is where you answer the vacancy specific questions. The 4th progress step is where you submit required documents (only if applicable to you) specified in the "Required Documents" section of this vacancy . Warning: BE SURE TO pull documents from your USAJOBS Account by clicking "U" UPLOAD icon under "Action". If you submit a document using the same document title, the 2nd submission will OVERWRITE the 1st submission.
STEP 4 – On the “Application Review” step, click “Submit Application”
The last “Confirmation” step will turn green noting that your application was submitted successfully.
STEP 5 - Edit Application as needed by 11:59 pm ET of Close Date by returning to USAJOBS and clicking the vacancy, then “Update Application”.
Labor, Ofc of Workers' Compensation Programs
200 Constitution Ave., NW
Washington, DC 20210
US
Next steps
Once your complete application is received, we will conduct an evaluation of your qualifications and refer candidates for selection consideration. Candidates will be referred to the hiring manager for further consideration and possible interview. You will be notified of the outcome. A selection is expected to be made within 30 calendar days from the issuance date of the certificate.
The following documents must be submitted by 11:59 p.m. (ET) on the vacancy closing date. Follow the instructions: click How To Submit Supplemental Documentation Document. You are not required to submit a document if it does not apply to you. Warning: If you submit a document using the same document title, the 2nd submission will OVERWRITE the 1st submission. Also, do not upload password protected documents.
- Veterans Documents (if applicable): To be considered as a 5-point preference eligible, you must submit a copy of your Certificate of Release or Discharge From Active Duty, DD214. Your DD-214 must show the type of discharge and dates of active duty. To claim 10-point preference, you must submit a copy of your DD214; an Application for 10-point Veteran's Preference, SF15; and the proof of entitlement of this preference which is normally an official statement, dated 1991 or later, from the Department of Veterans Affairs certifying to the present existence of the service-connected disability and indicating the percentage of your disability. (For active duty service members expecting honorable or general discharge or release within 120 days, click Active Duty). Without this documentation, you will not receive veteran's preference. For more information, go to: http://www.fedshirevets.gov/hire/hrp/vetguide/index.aspx
- Displaced Employee Placement Documents – Only required if requesting priority consideration under CTAP or ICTAP eligibility.
- Cover Letters are not mandatory and will not be used to verify experience, but may be submitted
Applicants selected for employment who are not current DOL employees will be required to provide proof of citizenship, and the E-Verify system will be used to confirm the employment eligibility of all new hires.
If you are relying on your education to meet qualification requirements:
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
Follow the steps below to apply. Your application and ALL required supplemental documents must be received before the job closes – since this job has an application limit of 50, it will close at 11:59 pm Eastern Time (ET) ON THE DATE THIS LIMIT IS REACHED or ON THE VACANCY CLOSING DATE, whichever OCCURS FIRST. If the job closes on the date the limit is reached, applicants will no longer be able to edit their applications. Paper applications and supplemental documents submitted in any other manner without prior approval from the vacancy contact will not be considered.
SAVE your information before the 30 MINUTE TIMEOUT! For help, go to https://www.usajobs.gov/Help/how-to/.
STEP 1 - Create USAJOBS Account on www.usajobs.gov, including Resume and Saved Documents
Your resume must provide sufficient information to substantiate your responses in the self-assessment vacancy questions. If not, HR may amend your responses to more accurately reflect the competency indicated by resume content. FOR EACH EMPLOYMENT PERIOD, include: start/end month & year and note full-time or part-time (if part-time, include # of hours worked per week); otherwise, your application may be considered incomplete.
STEP 2 - Complete the 1st part of the application process (USAJOBS)
Once you have identified a job on www.usajobs.gov that you wish to apply for, click on the title and click the Apply button . For questions about the vacancy, click the “Agency Contact Information” link. Click “Start Application” and proceed through 5 steps noted at the top of the USAJOBS page. You will be able to select a resume and documents from your USAJOBS Account that you can submit as a package as part of your DOL application. At Step 5, click “Continue to Agency Site”.
STEP 3 – Complete the 2nd part of the application process (DOL)
On the Department of Labor (DOL) page, create a DOL Account and click “APPLY TO THIS VACANCY”. Continue through the 7 progress steps noted at the top of the DOL page. The 3rd progress step is where you answer the vacancy specific questions. The 4th progress step is where you submit required documents (only if applicable to you) specified in the "Required Documents" section of this vacancy . Warning: BE SURE TO pull documents from your USAJOBS Account by clicking "U" UPLOAD icon under "Action". If you submit a document using the same document title, the 2nd submission will OVERWRITE the 1st submission.
STEP 4 – On the “Application Review” step, click “Submit Application”
The last “Confirmation” step will turn green noting that your application was submitted successfully.
STEP 5 - Edit Application as needed by 11:59 pm ET of Close Date by returning to USAJOBS and clicking the vacancy, then “Update Application”.
Labor, Ofc of Workers' Compensation Programs
200 Constitution Ave., NW
Washington, DC 20210
US
Next steps
Once your complete application is received, we will conduct an evaluation of your qualifications and refer candidates for selection consideration. Candidates will be referred to the hiring manager for further consideration and possible interview. You will be notified of the outcome. A selection is expected to be made within 30 calendar days from the issuance date of the certificate.
