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.
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.
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
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.
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.
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.
IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE.
Narrative responses are not required at this time. If you are referred for consideration, you may be asked to submit additional job related information, which may include, but not limited to; responses to the knowledge, skills and abilities; completion of a work sample, and/or contact for an interview. Your resume and/or supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect your rating or consideration for employment.
The Department of Veterans Affairs performs pre-employment reference checks as an assessment method used in the hiring process to verify information provided by a candidate (e.g., on resume or during interview or hiring process); gain additional knowledge regarding a candidate's abilities; and assist a hiring manager with making a final selection for a position.
Placement Policy: The posting of this announcement does not obligate management to fill a vacancy or vacancies by promotion. The position may be filled by reassignment, change to lower grade, transfer, appointment, or reinstatement. Management may use any one or any combination of these methods to fill the position.
It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment.
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.
To apply for this position, you must provide a complete Application Package which includes:
Resume
SF-50/ Notification of Personnel Action
The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this position. Please make sure you have included other documents required for your application, such as a copy of your transcript (if using education to qualify), SF-50's (current/former Federal employees), documentation to support Veterans Preference claims, or ICTAP/CTAP documentation (for displaced Federal employees). You will not be contacted for additional information.
Cover Letter
Other (1)
Resume
SF-50/ Notification of Personnel Action
Transcript
SF-50, Notification of Personnel Action (if applicable for Time in Grade and/or Eligibility):
Most recent SF-50 if you are a current or former Federal employee
An SF-50 showing 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
Award 50's do not provide sufficient information and will not be accepted for the purpose of verifying time-in-grade.
Examples of appropriate SF-50's include:
Within grade increases at the highest grade held; or
Promotions with an effective date more than one year old; or
SF-50's at the highest grade held with an effective date more than one year old.
Veterans' preference does not apply for internal permanent agency employees.
If you are relying on your education to meet qualification requirements:
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.
All applicants are encouraged to apply online. To apply for this position, you must complete the questionnaire and submit the documentation specified in the Required Documents section below. The complete application package must be submitted by 11:59 PM (ET) on 06/20/2025 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/12746965.
To begin, click Apply Online to create a USA JOBS account or log in to your existing account. Follow the prompts to select your USA JOBS resume and/or other supporting documents and complete the occupational questionnaire.
Click Submit My Answers to submit your application package.
NOTE: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.
The Career Transition Assistance Plan (CTAP) provide eligible displaced VA competitive service employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit appropriate documentation (a copy of the agency notice, your most recent performance rating, and your most recent SF-50 noting current position, grade level, and duty location) and be found well-qualified for this vacancy. To be well-qualified: applicants must possess experience that exceeds the minimum qualifications of the position including all selective factors, and who are proficient in most of the required competencies of the job. Information about CTAP eligibility is on OPM's Career Transition Resources website at http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/.
During the application process you may have an option to opt-in to make your resume available to hiring managers in the agency who have similar positions. Opting in does not impact your application for this announcement, nor does it guarantee further consideration for additional positions.
Edward Hines Junior Hospital
5000 South 5th Avenue
Hines, IL 60141
US
Next steps
Once your online application is submitted you will receive a confirmation notification by email. After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email. Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made.
You may check the status of your application at any time by logging into your USA Jobs account and clicking on Applications. Information regarding your application status can be found in the USAJobs Help Center.
NOTE: Participation in the seasonal influenza program is a condition of employment and a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). It is a requirement that all HCP to receive annual seasonal influenza vaccination or obtain an exemption for medical or religious reasons. Wearing a face mask is required when an exemption to the influenza vaccination has been granted. HCP in violation of this directive may face disciplinary action up to and including removal from federal service. HCP are individuals who, during the influenza season, work in VHA locations or who come into contact with VA patients or other HCP as part of their duties. VHA locations include, but are not limited to, VA hospitals and associated clinics, community living centers (CLCs), community-based outpatient clinics (CBOCs), domiciliary units, Vet centers and VA-leased medical facilities. HCP include all VA licensed and unlicensed, clinical and administrative, remote and onsite, paid and without compensation, full- and part-time employees, intermittent employees, fee basis employees, VA contractors, researchers, volunteers and health professions trainees (HPTs) who are expected to perform any or all of their work at these facilities. HPTs may be paid or unpaid and include residents, interns, fellows and students. HCP also includes VHA personnel providing home-based care to Veterans and drivers and other personnel whose duties put them in contact with patients outside VA medical facilities.
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
To apply for this position, you must provide a complete Application Package which includes:
Resume
SF-50/ Notification of Personnel Action
The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this position. Please make sure you have included other documents required for your application, such as a copy of your transcript (if using education to qualify), SF-50's (current/former Federal employees), documentation to support Veterans Preference claims, or ICTAP/CTAP documentation (for displaced Federal employees). You will not be contacted for additional information.
Cover Letter
Other (1)
Resume
SF-50/ Notification of Personnel Action
Transcript
SF-50, Notification of Personnel Action (if applicable for Time in Grade and/or Eligibility):
Most recent SF-50 if you are a current or former Federal employee
An SF-50 showing 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
Award 50's do not provide sufficient information and will not be accepted for the purpose of verifying time-in-grade.
Examples of appropriate SF-50's include:
Within grade increases at the highest grade held; or
Promotions with an effective date more than one year old; or
SF-50's at the highest grade held with an effective date more than one year old.
Veterans' preference does not apply for internal permanent agency employees.
If you are relying on your education to meet qualification requirements:
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.
All applicants are encouraged to apply online. To apply for this position, you must complete the questionnaire and submit the documentation specified in the Required Documents section below. The complete application package must be submitted by 11:59 PM (ET) on 06/20/2025 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/12746965.
To begin, click Apply Online to create a USA JOBS account or log in to your existing account. Follow the prompts to select your USA JOBS resume and/or other supporting documents and complete the occupational questionnaire.
Click Submit My Answers to submit your application package.
NOTE: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.
The Career Transition Assistance Plan (CTAP) provide eligible displaced VA competitive service employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit appropriate documentation (a copy of the agency notice, your most recent performance rating, and your most recent SF-50 noting current position, grade level, and duty location) and be found well-qualified for this vacancy. To be well-qualified: applicants must possess experience that exceeds the minimum qualifications of the position including all selective factors, and who are proficient in most of the required competencies of the job. Information about CTAP eligibility is on OPM's Career Transition Resources website at http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/.
During the application process you may have an option to opt-in to make your resume available to hiring managers in the agency who have similar positions. Opting in does not impact your application for this announcement, nor does it guarantee further consideration for additional positions.
Edward Hines Junior Hospital
5000 South 5th Avenue
Hines, IL 60141
US
Next steps
Once your online application is submitted you will receive a confirmation notification by email. After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email. Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made.
You may check the status of your application at any time by logging into your USA Jobs account and clicking on Applications. Information regarding your application status can be found in the USAJobs Help Center.
NOTE: Participation in the seasonal influenza program is a condition of employment and a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). It is a requirement that all HCP to receive annual seasonal influenza vaccination or obtain an exemption for medical or religious reasons. Wearing a face mask is required when an exemption to the influenza vaccination has been granted. HCP in violation of this directive may face disciplinary action up to and including removal from federal service. HCP are individuals who, during the influenza season, work in VHA locations or who come into contact with VA patients or other HCP as part of their duties. VHA locations include, but are not limited to, VA hospitals and associated clinics, community living centers (CLCs), community-based outpatient clinics (CBOCs), domiciliary units, Vet centers and VA-leased medical facilities. HCP include all VA licensed and unlicensed, clinical and administrative, remote and onsite, paid and without compensation, full- and part-time employees, intermittent employees, fee basis employees, VA contractors, researchers, volunteers and health professions trainees (HPTs) who are expected to perform any or all of their work at these facilities. HPTs may be paid or unpaid and include residents, interns, fellows and students. HCP also includes VHA personnel providing home-based care to Veterans and drivers and other personnel whose duties put them in contact with patients outside VA medical facilities.
Fair and transparent
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
