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Summary This position is located at the Edward Hines Jr. VA Hospital, Hines, IL (578) - a Level 1a Complexity VHA Facility and is organizationally aligned under the Office of the Director. The primary purpose of the position is to perform a variety of complex auditing activities for various business operations of Edward Hines Jr. VA Hospital, including the Community Based Outpatient Clinics (CBOC) in support & oversight of the facility integrity and compliance program. Responsibilities This position performs functions associated with the initial and continued development and oversight of the facility IC Program. Elements of the facility IC Program include, but not be limited to: preventing illegal and/or unethical conduct responding to alleged violations of law, rule or regulation; and reporting alleged violations to appropriate existing channels for investigations and resolution planning program objectives; developing risk management solutions and associated mitigation plans, such as, monitoring and auditing, and creating training and education plans. Collaborates with the facility Integrity & Compliance Officer in planning, developing, and implementing programs to effectively identify, plan, assess, respond, and monitor areas of high risk, and coordinate efforts to improve performance as deemed necessary while performing VHA and other mandated audits and reviews of compliance program areas. These areas include: insurance identification and verification enrollment; eligibility; utilization review; pre-certification/certification; billing, coding, documentation; audits, reviews, inquiries, and remediation; accounts receivable and payable; HHS OIG exclusionary list; information protection, record retention, managing requests for information; provider documentation; staff education/training in compliance; management of the IC Helpline and database tracking system; overpayments; questionable conduct on the part of management, supervisors, or employees, Non-VA Medical Care and any other matter relating to the business integrity of VHA operations. Performs quality review audits on these areas to ensure that the facility business operations are accurate and reliable, and will also perform in depth reviews and audits of perceived problem areas discovered during routine monitoring program Develops methodologies for reviews and audits of all facets of the Compliance Program Provides evaluation of documentation of medical services to insure that all services documented are in compliance with established guidelines Provides audits and analyses of data entered into VISTA, CPRS, CPT codes, encounter documentation, enrollment data, means testing and workload Audits and feedback will be provided to clinical staff Assistance is provided to health care providers to educate providers in the penalties and consequences of incorrect workload input, incorrect coding and inadequate documentation Provides educational assistance to facility staff under the direction of the Integrity & Compliance Officer Provides technical & administrative advisory service while collaborating with the IC Office Performs other related duties as assigned. Work Schedule: Monday - Friday 7:30 am - 4:00 pm Compressed/Flexible: Not Authorized Telework: Not Authorized Virtual: This is not a virtual position Position Description/PD#: Health Systems Specialist ( Integrity and Compliance Auditor)/PD170010 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. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued dentification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP) Qualifications To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 06/20/2025. 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-9. 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. BASIC REQUIREMENTS: You must have one of the following: EDUCATION: Undergraduate or Graduate Education with a major study in hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. OR, 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. GS-11 Grade Requirements: You may qualify based on your experience and/or education as described below: Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-9 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 the healthcare industry including Veterans Affairs regulations (e.g., audit by objectives and internal control programs, to ensure that audit coverage is appropriate to meet established audit objectives. Knowledge of CMS guidelines, as well as the laws, statutes, regulations and guidance related to compliance programs and ethics rules to keep apprised of new guidance for implementation. Comprehensive knowledge of the VA's eligibility regulations concerning Purchased Care, authorized and nonauthorized care and medical provided under TriCare, and ChampVA. Comprehensive knowledge of management principles including prioritization, personnel management, team building, and statistical/analytical skills related to process evaluation, improvement, and reengineering, and strong computer skills. Comprehensive knowledge of theories, practices, methods, and techniques of auditing. Knowledge of management information system and office automation applications, principles, and practices. Knowledge of medical terminology and procedural nomenclature, health care record and coding processes to accurately assess, analyze, evaluate and facilitate best practices in medical records coding. Comprehensive knowledge of investigative principles and techniques in order to design and coordinate compliance reviews and/or monitoring activities. Skill in applying complex fact finding, analytical and problem solving methods and techniques. Skill in oral and written communication to prepare and present recommendations. Ability to establish effective relationships with supervisors, managers, and coworkers to effectively manage complex issues. OR, Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have a Ph.D. or equivalent doctoral degree; or 3 full years of progressively higher level graduate education leading to such a degree; or LL.M., if related. OR, Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and higher graduate education as described above. You may qualify based on your experience and/or education as described below: You will be rated on the following Competencies for this position: Auditing Interpersonal Effectiveness Organizational Performance Analysis 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. Physical Requirements: The work is primarily sedentary. The incumbent uses a computer and standard office equipment to complete tasks. Physical activity involves walking, bending, or stooping, climbing stairs, carrying supplies. No special physical demands are required to perform the work. 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. 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.