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. Responsibilities 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. Requirements Conditions of Employment Qualifications To qualify for the position of Medical Advisor, at GS-0601-15, you must meet the qualification requirements listed below. 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 close of this announcement. Your resume must support your responses to the online questionnaire and the qualification requirements. Failure to do so may result in an ineligible rating. 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. If you are relying on your education to meet qualification requirements, please see the statements below. 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 towards your qualifications. Therefore, provide only the attendance and/or degrees from accredited institution. FOREIGN EDUCATION: Education completed in foreign colleges or universities may be used to meet the requirements. You must show proof the education credentials have been deemed to be at least equivalent to that gained in a conventional U.S. education program. It is your responsibility to provide such evidence when applying. For special instructions pertaining to foreign education and a list of organizations that can evaluate foreign education, see the Department of Education website. If you are qualifying on foreign education, you MUST submit proof of creditability of education as evaluated by a credentialing agency. Transcripts must be uploaded with your application to verify education. All documentation must be in English or include an English translation. Additional Information Additional selections may be made from this announcement. Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution. Candidates will not be hired based on their race, sex, color, religion, or national origin. 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: 1. Meet CTAP or ICTAP eligibility criteria; 2. Be rated well-qualified for the position [with a score of 85] based on the competencies listed above; and 3. Submit the appropriate documentation to support your CTAP or ICTAP eligibility. Probationary Period: As a condition of employment for accepting this position, you may be required to serve a 1-year As a condition of employment for accepting this position, you may be required to serve a 1-year probationary period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider: 1) your performance and conduct; 2) the needs and interests of the agency; 3) whether your continued employment would advance organizational goals of the agency or the Government; and 4) whether your continued employment would advance the efficiency of the Federal service. Upon completion of your probationary period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest. EEO Statement/Policy: The United States government does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, 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. More information can be found here: https://www.justice.gov/jmd/media/1425556/dl?inline. DOJ Reasonable Accommodation Policy: Federal agencies must provide reasonable accommodation to applicants with disabilities where appropriate. Applicants requiring reasonable accommodation for any part of the application and hiring process should contact the hiring agency directly. Determinations on requests for reasonable accommodation will be made on a case-by-case basis. The DOJ Reasonable Accommodation policy can be found here: https://www.justice.gov/jmd/reasonable-accommodation#policy 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. Note: In accordance with 5 U.S. Code § 9202(c) and 5 C.F.R § 920.201(b) certain positions are exempt from the provisions of the Fair Chance Act.
