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Summary This position is located in the Executive Director Department of the JJP VA Medical Center in the Bronx, NY. The Health System Specialist serves as the Integrity Compliance Specialist/Analyst for the OIC under the ICO who reports to the Director. The position serves as the principle advisor to the ICO and independently provides facility-wide analysis/reviews of revenue cycle and community care data as well as other facility-wide risk reviews/analysis. Responsibilities MAJOR DUTIES AND RESPONSIBILITIES: Office of Integrity and Compliance Program Management: The Health System Specialist functioning as Compliance Specialist/Analyst is responsible for completing programmatic auditing of facility-wide revenue process and community care oversight. Participates in systematic reviews of services. Assists in developing, implementing, or coordinating the implementation of corrective actions resulting from such reviews. The position ensures that all policies, procedures, and VHA Directive and guidance are being implemented. Page 2 of 8 The incumbent processes the reviews through the entire flow of reimbursement and billing to include the following: auditing, performing route cause analysis, identifying areas of improvement, making recommendations of corrective actions, trending data, and then follow up with key business process owners of the operations. Development of Programs, Policies, and Procedures: Develops programs to ensure that compliance program provisions are planned, developed and implemented to identify, prevent and correct unsatisfactory conditions and elements which influence the regulatory correctness and responsiveness of business and services. Develops databases and spreadsheets for tracking and trending results of analyses. Identifies indicators, progress measures, objectives and emphasis areas that are potentially non-compliant according to the VHA rules and regulations. Studies and Special Projects - Internal Controls and Oversight: Percent Designs studies, training programs and organizational strategies for identifying opportunities to improve performance and ensure adequate internal controls are in-place. Analyzes key steps in transaction process or business practice to identify potential material weaknesses. On a periodic basis assists the Integrity Compliance Officer in performing local health care system-wide reviews of internal controls effectiveness. Assists managers and staff to develop and implement internal control measures and monitors if there is a high risk of operational failure. Development of Criteria: Page 4 of 8 Develops reporting procedures, sampling techniques, and measurements at various points of the revenue program or business cycle to identify problem areas or inherent weaknesses in work processes, procedures, information systems and content. Develops indicators and monitors to provide objective evidence of the effectiveness of quality procedures and controls. Performs in depth analysis of stable work processes or service delivery practices to identify reasonable and efficient quality measurements tailored to the activity. Monitors quality program implementation and indicators designed to prevent erroneous transactions and ineffective work practices and to verify adherence to quality plans and requirements. Program Implementation: Investigates and analyzes adverse quality trends or conditions and recommends corrective action. Consults with technical experts to examine and analyze unusual or problem situations indicated by changes in program quality indicators. Performs in-depth research, analyzes operating contingencies and special situations. Assists managers and staff in developing process solutions. Perform other duties as assigned, normally of a related nature. Work Schedule: Monday to Friday 8am to 4:30pm Telework: This is not a telework position. Virtual: This is not a virtual position. Position Description/PD#: Health System Specialist/PD11363-0 Requirements Conditions of Employment You must be a U.S. Citizen to apply for this job Selective Service Registration is required for males born after 12/31/1959 You may be required to serve a probationary period Subject to background/security investigation Selected applicants will be required to complete an online onboarding process Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP) Participation in the Coronavirus Disease 2019 (COVID-19) vaccination program is a requirement for all Veterans Health Administration Health Care Personnel (HCP) - See "Additional Information" below for details. Qualifications To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 12/02/2024. 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-11 position you must have served 52 weeks at the GS-09. 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. AND Individual Occupational Requirement (IOR): The 0671 series requires specific education or experience to be met in order to be appointed into a position of this series. You must meet one of the pre-determined Education or Experience Individual Occupational Requirements listed below as set by Office of Personnel Management (OPM).Undergraduate and Graduate Education: Major Study - hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. Note: If you are basing part of your qualifications on education, a transcript must be submitted with your application. OR, Specialized Experience: Progressively responsible analytical or administrative, or clinical management or supervisory experience in the health care field. This work may have been performed in an operating health care facility or a higher organizational echelon with advisory or directional authority over such facilities. Work must have involved a close working relationship with facility managers and analysis and/or coordination of administrative, clinical, or other service activities, and provided knowledge of the following: Missions, organizations, programs, and requirements of health care delivery systems; Regulations and standards of various regulatory and credentialing groups; and Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement. OR, Special Provision for In-service Placement successful completion of an agency-sponsored on-the-job training program may be substituted for qualifying experience, provided it included a formal individualized training plan. Such a training program must have been conducted in an operating health care system and included: Assignments providing a knowledge of basic health system administration philosophies, practices, and procedures, and basic government administrative policies and requirements; Practical assignments providing an opportunity to apply health system administration skills and principles (as the individual progresses, work assignments must be characteristic of the grade level to which he or she is assigned); and Oversight by an experienced health system administrator with periodic evaluation of the individual's progress and appropriate adjustment of the training program. In addition to the Time in Grade and IOR requirement listed above, you must also qualify based on your experience/education as described below: Specialized Experience Requirement: Do you have one year of specialized experience equivalent to at least the next lower grade GS-09 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Comprehensive knowledge of auditing, performing route cause analysis, identifying areas of improvement, making recommendations of corrective actions, trending data, and then follow up with key business process owners of the operations as well as, analytical/evaluative methods for development and management of a major administrative program for the assessment and improvement of program effectiveness or the improvement of complex management processes and systems; knowledge of the range of national administrative laws, policies, regulations, and precedents applicable to the administration and develop programs, policies, and procedures; Skill in a wide variety of computer and data management packages; Sufficient skills to plan, audit, gather and analyze data to accept and implement recommendations where conflicting goals may exist; Knowledge of Federal government policies, regulations, and trends in the areas of management systems; Ability to apply the above knowledge and understanding of goals and requirements for delivery of effective, and providing compliance training. OR, Education (Transcripts required): Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have Successfully completed a Ph.D. or equivalent doctoral degree, or 3 full years of progressively higher-level graduate education leading to such a degree, or an LL.M. if related. OR, Combination: Applicants may also combine education and experience to qualify at this level. You must have equivalent combinations of successfully completed graduate level education (in excess of the first two graduate years or 36 semester hours) and specialized experience to meet total experience requirements. NOTE: If using education combined with specialized experience to qualify, a copy of your transcript is required. You will be rated on the following Competencies for this position: Analytical Reasoning Audit Reporting Planning and Evaluating Teaching Others Technical Competence 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. Preferred Experience: 1 year experience assisting in performing compliance activities or other related activities within a healthcare setting such as a hospital or Medical Facility. General knowledge of Medical center policies and procedures regarding compliance. Possesses general body of knowledge in developing monitoring and auditing plans of revenue cycle activities. Possesses general body of knowledge and has ability in formation of a risk assessment and management plan. Assisted in developing a training and education plan. Demonstrate ability to use various data analytical software (Microsoft Excel, Access, etc) to review and analyze data. Physical Requirements: The work involves intense concentration and relatively long periods of sitting with some walking. Training involves interactions with coders, billing staff, medical staff and others as appropriate. Page 7 of 8 Work is generally sedentary, working predominately with the computer, but standing, bending, walking and carrying of lightweight items such as reports and manuals are required. 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/. Education A transcript must be submitted with your application if you are basing all or part of your qualifications on education. Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/. Additional Information This job opportunity announcement may be used to fill additional vacancies. Pursuant to VHA Directive 1193.01, VHA health care personnel (HCP) are required to be fully vaccinated against COVID-19 subject to such accommodations as required by law (i.e., medical, religious or pregnancy). VHA HCPs do not include remote workers who only infrequently enter VHA locations. If selected, you will be required to be fully vaccinated against COVID-19 and submit documentation of proof of vaccination before your start date. The agency will provide additional information regarding what information or documentation will be needed and how you can request a legally required accommodation from this requirement using the reasonable accommodation process. If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement. Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act.