Duties

Summary

This position is located in the U.S. Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP), Division of Administrative Operations (DAO), Branch of Medical Standards and Rehabilitation (BMSR), Washington, DC.

Learn more about this agency

Responsibilities

OWCP administers four critical benefit programs [Federal Employees' Compensation Act (FECA) program; the Longshore and Harbor Workers' Compensation Act (LHWCA) program; the Black Lung Benefits Act program; and the Energy Employees' Occupational Illness Compensation Program (EEOICP)] for workers who become ill or are injured on the job by ensuring income support for these workers when work is impossible or unavailable due to their injury or illness.

DOL encourages persons with disabilities to apply, including eligible under 5 CFR 213.3102(u), Schedule A [i.e. intellectual disabilities, severe physical disabilities, or psychiatric disabilities].

-This position is outside the bargaining unit.

-Additional selections may be made from this announcement.

DUTIES

Provides oversight and direction regarding the development, implementation, and operation of the OWCP Medical Bill Processing System and related system functions and activities [e.g., medical provider registration, claimant and provider inquiries, central mailroom activities, PBM services, fiscal operations, program integrity, and medical bill coding]. This nationwide system improves the day-to-day strategic management of OWCP business operations. Fosters communication and working relationships with respective Physicians, Information Systems Development Officers (ISDO), Contracting Officer's Representatives (COR), and Program liaisons in planning and directing transition/modernization operations to a new medical bill payment system. Provides continuity, assistance, and guidance to OWCP subject matter experts and ensures that all requisite requirements have been met.

Serves as the OWCP authority for the Agency's medical bill and pharmacy processing systems. In this capacity, the incumbent has overall responsibility for overseeing the design, development, testing, and evaluating lifecycle phases;establishing short- and long-term system objectives; setting and adjusting priorities; ensures ongoing modifications are implemented in the systems and changes in procedures are made compatible with OWCP programs; oversees research and analytical efforts designed to identify and address overall system problems arising during system development that impact current business practices and ensures solutions work for all system users and OWCP objectives and goals are not adversely impacted. Designs reporting methods and monitors system performance through various means(e.g., performance reporting, trend analysis, and internal and external stakeholder surveys/feedback).

Formulates, develops, and implements appropriate policies and procedures for the OWCP Medical Bill Processing System as well as special procedural and policy needs of individual programs. Consults with Physicians in determining new or revised policy and procedural guidance for effective medical system operation. Makes recommendations to specific OWCP Programs' policies and procedures as new system requirements are identified and Program feedback is received to ensure complete alignment.

Serves as a principal advisor to OWCP executive leadership by providing information within area of expertise to make informed decisions concerning program integrity, objectives, and the prevention and detection of fraud, risk, and abuse. Consults with the Office of Inspector General (OIG) regarding potential fraud and abuse in the amounts and types of medical treatment, costs, and pharmaceuticals relative to workers' compensation.

As the Branch Chief, the incumbent provides oversight for all strategic planning initiatives regarding the OWCP Medical Bill Processing System, which includes pharmacy benefits management, medical treatment guidelines, and medical fee schedule methodologies.

Provides oversight of the pharmaceutical aspects of the medical bill processing system and PBM. Renders subject matter advice and expertise on the therapeutics and economics of drug treatments; approval or rejection of PBM service provider recommendation; the development and maintenance of formularies and exclusion lists; the development of drug-related policies and procedures; and the use of prescription and non-prescription drugs.

Assists in preparing the Secretary and OWCP Director for the presentation of testimony before Congress and/or may be called upon to provide direct testimony. Assists in the design and development of reports, papers, or other materials to Congress. Guides the preparation of the Secretary and OWCP Director for testimony and engagement.

Travel Required

25% or less - Travel is for training and meetings.

Supervisory status
Yes

Promotion Potential
15 - If selected at the GS-15 level, no further promotion potential exist.

Requirements

Conditions of Employment

• Candidate required to obtain the necessary security/investigation level.
• Appointment to this position may require a background investigation.
• Subject to financial disclosure requirements.
• Requires a probationary period if the requirement has not been met.
• Must be at least 16 years old and a U.S. Citizen.

You may not be aware, but in the regulations for agency ethics programs, there are requirements for supervisors. Section 2638.103 of Title 5 of the CFR states:

Every supervisor in the executive branch has a heightened personal responsibility for advancing government ethics. It is imperative that supervisors serve as models of ethical behavior for subordinates. Supervisors have a responsibility to help ensure that subordinates are aware of their ethical obligations under the Standards of Conduct and that subordinates know how to contact agency ethics officials. Supervisors are also responsible for working with agency ethics officials to help resolve conflicts of interests and enforce government ethics laws and regulations, including those requiring certain employees to file financial disclosure reports. In addition, supervisors are responsible, when requested, for assisting agency ethics officials in evaluating potential conflicts of interest and identifying positions subject to financial disclosure requirements.Applicants must meet time-in-grade, time-after-competitive-appointment and qualifications requirements within 30 calendar days after the closing date of the vacancy to be eligible for consideration for selection.

Federal Employees Please Note: Your SF-50 must include enough information to be able to determine that time-in-grade requirements have been met and reflects your position title, pay plan/series/grade, tenure and the type of appointment (i.e. competitive/excepted). In some cases you may need to submit more than one SF-50.

Reference the "Required Documents" section for additional requirements.

Candidate required to obtain the necessary security/investigation level.

Qualifications

"IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE.

Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, GS-14, in the Federal Service.

Specialized experience is defined as:

Experience directing and advising subordinates to include both licensed medical professionals (i.e., doctors, pharmacists and nurses) and/or non-medical personnel(i.e., medical coding specialist, analysts and workers compensation specialists) on centralized medical/pharmaceutical/healthcare bill processing and payment systems.

Experience in applying quality management principles, laws and regulations in the development, implementation and revision of policies and procedures pertaining to medical and pharmacy benefits payment systems processing (relating to industry standards).

Experience managing the development and implementation of internal controls based on medical audit findings to prevent and detect fraud, waste and abuse in a healthcare setting.

Education

There is no educational substitution for this position at this grade level.

Additional information

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.

Federal Employees Please Note: Your SF-50 must include enough information to be able to determine that time-in-grade requirements have been met and reflects your position title, pay plan/series/grade, tenure and the type of appointment (i.e. competitive/excepted). In some cases you may need to submit more than one SF-50.

Refer to these links for more information: GENERAL INFORMATION , ADDITIONAL DOCUMENTATION , FORMER FEDERAL EMPLOYEES

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

Click here for Evaluation details. For Displaced Employees ONLY: if you meet the eligibility requirements for special priority selection under ICTAP / CTAP , you must be well-qualified for the position to receive consideration for special priority selection. ICTAP/CTAP eligibles will be considered "well-qualified" if they attain at least a rating score of 85 in a numerical rating scheme. Be sure to review DOL Account Eligibility Questions #24 and 27 to reflect that you are applying as an ICTAP/CTAP eligible and submit supporting documentation.

Evaluation Factors (Competencies) - All qualified applicants will be evaluated on the following key competencies:

-Technical Credibility - Understands and appropriately applies principles, procedures, requirements, regulations and policies related to specialized expertise.

-Project Management- Knowledge of the principles, methods, or tools for developing, scheduling, coordinating, and managing projects and resources, including monitoring and inspecting costs, work, and contractor performance.

-Leadership - Influences, motivates and challenges others; adapts leadership styles to a variety of situations.

-Communications - Expresses ideas and facts to individuals or groups effectively; makes clear and convincing presentations; listens to others; facilitates an open exchange of ideas.

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). Your evaluation may also include a review by an HR Specialist or panel and may include other assessment tools (ex. interview, structured interview, written test, work sample, etc). The examining Human Resources Office (HRO) makes the final determination concerning applicant ratings. Your resume MUST provide sufficient information to substantiate your vacancy question responses. If not, the HRO may amend your responses to more accurately reflect the level of competency indicated by the content of your resume.

To preview questions please click here .

Background checks and security clearance

Security clearance
Not Required

Drug test required
No

Required Documents

The following documents must be submitted by 11:59 p.m. (ET) on the vacancy closing date. 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.

The following documents are required from all applicants (PLEASE READ CAREFULLY):

ARE YOU A CURRENT OR FORMER FEDERAL EMPLOYEE? If applying as a status candidate with current or former Federal Service, please provide a copy of your last or most recent SF-50, "Notification of Personnel Action" which shows your appointment eligibility for the position for which you are applying. Your SF-50 must identify the highest grade you held on a permanent basis, Pay Plan/Pay Schedule, Series, and Grade/Pay Band, and career status. Multiple SF-50 may be submitted to demonstrate your highest previous rate and eligibility.

*WARNING: An award SF-50 (ex. cash or time off award) may not indicate grade, step and competitive status. For current DOL employees, an award SF-50 DOES NOT indicate grade and step.

- Most recent performance appraisal/evaluation signed and dated within 18 months is requested by the agency, but will not disqualify candidates if not submitted. If not submitted during the application process, one may/will be requested at the time of the interview if the opportunity is extended. Applies to current and former Federal employees.

- Land Management Eligibles: a copy of your most recent Notification of Personnel Action (SF-50 or equivalent) proving your eligibility for appointment under the Land Management Workforce Flexibility Act. This service must have been performed in the competitive service, under a time limited appointment in a Land Management Agency, as defined by P.L. 114-328. For more information, click here .

The following documents are required if applicable:

- Displaced Employee Placement Documents - Only required if requesting priority consideration under ICTAP / CTAP Eligibility.

- DD-214 - verifying military service, eligibility for consideration under the Veterans Employment Opportunity Act (VEOA) and showing character of discharge (ex. Member Copy 4 and 2 are acceptable vs. Copy 1 which is not acceptable to adjudicate veteran's preference) & if applicable, VA letters reflecting overall combined disability rating.

- Special/Non-Competitive Appointing Authority Documents - Applicants who are eligible for consideration, and wish to be considered, under one of the following non-competitive hiring authorities must submit appropriate documentation (click on the links below to see the documentation requirements):

(a) Persons with Severe Disabilities (SCHEDULE A)
(b) Former Peace Corps Volunteers (PCV) OR Current or Former Peace Corps Employees (PCE)
(c) Military Spouses (MISP)

- 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:

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education .

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.