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.
Summary
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.
This position is being advertised under delegated examining procedures and is open to all U.S. Citizens. Preference for eligible veterans will be applied.
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.
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.
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.
SELECTIVE SERVICE: If you were born male, on or after December 31, 1959, you must certify that you have registered with the Selective Service System, or are exempt from having to do so under the Selective Service Law. Additional information is found at: www.sss.gov.
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.
Your application will be evaluated and rated under DOJ's Category Rating and Selection Procedures. Your resume and supporting documentation will be used to determine whether you meet the job qualifications listed on this announcement. If you are basically qualified for this job, your resume and supporting documentation will be compared to your responses on the Occupational Questionnaire. If you rate yourself higher than is supported by your application materials, your responses may be adjusted and/or you may be excluded from consideration for this job. If it is determined you meet minimum qualification requirements, your application will then be placed in one of three categories: Best Qualified, Highly Qualified, or Qualified. Within these categories, applicants eligible for Veterans' Preference will receive selection priority over non-veteran preference eligibles.
When addressing the specialized experience statement, applicants must present evidence of the experience in their resume. If the specialized experience statement is repeated, in the applicant's resume, Human Resources will deem the applicant as ineligible.
Your qualifications will be evaluated on the following competencies (knowledge, skills, and other characteristics):
Medicine and Dentistry
Oral Communication
Research
Technical Competence
Career Transition Programs (CTAP or ICTAP): These programs apply to Federal and/or DOJ employees who meet the definition of surplus or displaced from a position in the competitive service. To receive selection priority for this position, you must:
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.
Documentation requirements may vary from applicant to applicant based on your eligibility claims.
For example, Veteran documents would be required only from applicants claiming Veteran's Preference. It is your responsibility to carefully review the list of document descriptions below, to see which documents are required for your application.
ALL APPLICANTS: You must submit a detailed resume containing the following pieces of information for each job entry listed in your employment history:
Contact Information: Name, address, phone number, and email,
Official position title,
Employer name and contact information,
Start and end dates (including month and year),
A detailed list of duties & accomplishments,
Your grade/step achieved, and
The number of hours worked per week (or indicate full-time).
If you're unsure about what to include in your resume, please review the USAJOBS Resume Writing Tutorial on YouTube. You are encouraged to use the USAJOBS Resume Builder, as this will ensure you're including everything that is required.
When claiming a Veteran's Preference, you must submit your last DD-214 (Certificate of Release or Discharge from Active Duty) form, specifically the Member #4 Copy, indicating dates and character of service and discharge type.
If you are the qualifying parent or spouse of a disabled, deceased, or deployed Veteran, and are seeking a derived preference eligibility, you must submit appropriate supporting documentation such as the Veterans DD-214, SF-15, VA Letter, and/or Permanent Change of Station (PCS) orders. See Veteran Family Preference for more information.
For more information on each type of Veterans Preference, and the documentation required for each, see FedsHireVets.
If you are a displaced Federal employee claiming eligibility under CTAP or ICTAP:
You must submit your separation notice or agency RIF letter from your agency.
If you have not yet been separated, you can provide the letter of intent to separate you from the agency because of reduction-in-force.
If you are using education to qualify for this position, or education is required:
You must submit a transcript, which may be unofficial, as long as it contains a full listing of courses, credit earned, grade and grade-point-average, subject area, degree(s) earned, and dates of award.
Your transcript must come from a nationally-accredited educational institution recognized by the Department of Education.
Please do not submit electronic transcripts with documentation security protection, these may prevent our application system from accepting and processing the document.
To apply for this position, you must complete the online application questionnaire and submit your supporting documentation. Your complete application package must be submitted by 11:59 PM (EST) on 12/10/2024 to receive consideration.
Please note that if the vacancy has an application limit, it will be listed at the top of the announcement by USAJOBS, and the closing date may be sooner than listed here.
If you're not logged in to your USAJOBS account, you will need to login. If you don't have an account, please create one.
You will be prompted to select one of your stored (or uploaded) resumes, and any supporting documents you have uploaded to USAJOBS. If you have not uploaded these documents, you can do so later before submitting your application.
After acknowledging you have reviewed your application package, you will be asked to submit your demographic information (if you have provided this in your profile). Submission is optional and anonymous.
You'll be asked to confirm your choices and certify the accuracy of your information before you're able to continue to the Application Manager system. Until you see the blue border and DOJ logo, you are still on USAJOBS. You'll see a folder animation just before you leave USAJOBS.
Once you reach DOJ's Application Manager system, you'll be asked to verify the information you transmitted from USAJOBS. You will then respond to the application assessment questionnaires and indicate your eligibility options.
After responding to the questionnaires, you will have the opportunity to attach the documents you brought over from USAJOBS *OR* upload documents directly from your computer or device.
Once all your documents are uploaded, you must assign the uploads to the appropriate document category. You may attach more than one document to each category. Click the drop-down menu for a document category, and select one of the available options in the menu. The document will be listed under this category. You can click the drop-down again to add other documents, as needed. You can have up to 15 document assignments.
Once you've uploaded and assigned all your documents to an appropriate document type, you can proceed to the final verification step, and click Submit.
If you have correctly submitted your application, you will receive an automated e-mail notification within 30-60 minutes. Be sure to review the announcement fully to make sure that your application contains everything that is required.
If you need help with the application process, please see the USAJOBS Help Site (for everything on the USAJOBS-side), or the Application Manager Help Site (for everything on the DOJ-side). Regrettably, the Department of Justice cannot assist you with USAJOBS account issues. If you contact us for assistance and the problem is related to your USAJOBS account, we will have to direct you to USAJOBS to remedy the issue.
REASONABLE ACCOMMODATIONS:
If you are unable to apply online due to a disability or overseas deployment, you must request an alternative application, which is available from the Human Resources Office. Please contact Brandon Cox at brandon.l.cox@usdoj.gov or 202-598-9544 to discuss your situation. Accommodations are reviewed on a case-by-case basis. Indicate that you're asking for a reasonable accommodation in your e-mail subject so the HR Specialist knows where to direct you.
We strive to extend a final offer of employment within 90 days from the close of this announcement. Delays do sometimes occur for reasons beyond our control.
Additional selections may be made from this announcement, for up to 90 days, if additional openings occur in the office.
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
Documentation requirements may vary from applicant to applicant based on your eligibility claims.
For example, Veteran documents would be required only from applicants claiming Veteran's Preference. It is your responsibility to carefully review the list of document descriptions below, to see which documents are required for your application.
ALL APPLICANTS: You must submit a detailed resume containing the following pieces of information for each job entry listed in your employment history:
Contact Information: Name, address, phone number, and email,
Official position title,
Employer name and contact information,
Start and end dates (including month and year),
A detailed list of duties & accomplishments,
Your grade/step achieved, and
The number of hours worked per week (or indicate full-time).
If you're unsure about what to include in your resume, please review the USAJOBS Resume Writing Tutorial on YouTube. You are encouraged to use the USAJOBS Resume Builder, as this will ensure you're including everything that is required.
When claiming a Veteran's Preference, you must submit your last DD-214 (Certificate of Release or Discharge from Active Duty) form, specifically the Member #4 Copy, indicating dates and character of service and discharge type.
If you are the qualifying parent or spouse of a disabled, deceased, or deployed Veteran, and are seeking a derived preference eligibility, you must submit appropriate supporting documentation such as the Veterans DD-214, SF-15, VA Letter, and/or Permanent Change of Station (PCS) orders. See Veteran Family Preference for more information.
For more information on each type of Veterans Preference, and the documentation required for each, see FedsHireVets.
If you are a displaced Federal employee claiming eligibility under CTAP or ICTAP:
You must submit your separation notice or agency RIF letter from your agency.
If you have not yet been separated, you can provide the letter of intent to separate you from the agency because of reduction-in-force.
If you are using education to qualify for this position, or education is required:
You must submit a transcript, which may be unofficial, as long as it contains a full listing of courses, credit earned, grade and grade-point-average, subject area, degree(s) earned, and dates of award.
Your transcript must come from a nationally-accredited educational institution recognized by the Department of Education.
Please do not submit electronic transcripts with documentation security protection, these may prevent our application system from accepting and processing the document.
To apply for this position, you must complete the online application questionnaire and submit your supporting documentation. Your complete application package must be submitted by 11:59 PM (EST) on 12/10/2024 to receive consideration.
Please note that if the vacancy has an application limit, it will be listed at the top of the announcement by USAJOBS, and the closing date may be sooner than listed here.
If you're not logged in to your USAJOBS account, you will need to login. If you don't have an account, please create one.
You will be prompted to select one of your stored (or uploaded) resumes, and any supporting documents you have uploaded to USAJOBS. If you have not uploaded these documents, you can do so later before submitting your application.
After acknowledging you have reviewed your application package, you will be asked to submit your demographic information (if you have provided this in your profile). Submission is optional and anonymous.
You'll be asked to confirm your choices and certify the accuracy of your information before you're able to continue to the Application Manager system. Until you see the blue border and DOJ logo, you are still on USAJOBS. You'll see a folder animation just before you leave USAJOBS.
Once you reach DOJ's Application Manager system, you'll be asked to verify the information you transmitted from USAJOBS. You will then respond to the application assessment questionnaires and indicate your eligibility options.
After responding to the questionnaires, you will have the opportunity to attach the documents you brought over from USAJOBS *OR* upload documents directly from your computer or device.
Once all your documents are uploaded, you must assign the uploads to the appropriate document category. You may attach more than one document to each category. Click the drop-down menu for a document category, and select one of the available options in the menu. The document will be listed under this category. You can click the drop-down again to add other documents, as needed. You can have up to 15 document assignments.
Once you've uploaded and assigned all your documents to an appropriate document type, you can proceed to the final verification step, and click Submit.
If you have correctly submitted your application, you will receive an automated e-mail notification within 30-60 minutes. Be sure to review the announcement fully to make sure that your application contains everything that is required.
If you need help with the application process, please see the USAJOBS Help Site (for everything on the USAJOBS-side), or the Application Manager Help Site (for everything on the DOJ-side). Regrettably, the Department of Justice cannot assist you with USAJOBS account issues. If you contact us for assistance and the problem is related to your USAJOBS account, we will have to direct you to USAJOBS to remedy the issue.
REASONABLE ACCOMMODATIONS:
If you are unable to apply online due to a disability or overseas deployment, you must request an alternative application, which is available from the Human Resources Office. Please contact Brandon Cox at brandon.l.cox@usdoj.gov or 202-598-9544 to discuss your situation. Accommodations are reviewed on a case-by-case basis. Indicate that you're asking for a reasonable accommodation in your e-mail subject so the HR Specialist knows where to direct you.
We strive to extend a final offer of employment within 90 days from the close of this announcement. Delays do sometimes occur for reasons beyond our control.
Additional selections may be made from this announcement, for up to 90 days, if additional openings occur in the office.
Fair and transparent
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
