Health System Specialist (Compliance and Business Integrity Officer) - Veterans Health Administration : Job Details

SummaryThe Compliance and Business Integrity (CBI) Officer manages the planning, development, and implementation of compliance initiatives within the Medical Center and CBOCs. The Compliance Officer will function as an independent and objective person who reviews and evaluates compliance issues and concerns (as delineated under Major Duties and Responsibilities below) within the organization with limited guidance from the VACO CBI Program Office, the VISN CBI Officer and facility Director.This job is open to

• Internal to an agencyCurrent federal employees of this agency.

Clarification from the agencyThis position is open to current permanent VA employees at the Beckley VA Medical Center only.VideosDutiesMAJOR DUTIES AND RESPONSIBILITIES:1) Policies and Procedures

• Develop written compliance policies and procedures consistent with those established by VHA and Federal Laws that reflect industry standards and practice.
• Conduct ongoing studies of policies and procedures, resource utilization, and organizational structure for the revenue cycle as related to compliance issues and adapt, modify and change these as needed to conform to compliance standards.
• Continually review new and revised guidelines, set priorities based on this information, and develop organization-wide initiatives to effectively comply with all current and anticipated requirements.

2) Governance/Structure

• Promotes ethics standards in cooperation with Regional Counsel, OIG, and the local-designated ethics officer.
• Produces timely and accurate reports to the Director, Associate Director, VACO, the VISN CBI Officer, and other appropriate personnel and services accompanied by any necessary performance improvement recommendations.
• Develops and implements a CBI assessment process that will be used internally to determine efficiency and effectiveness of the CBI program as related to business operational areas.

3) Training and Education

• Responsible for creation of a written training and education plan to include organizational leadership and the members of the Compliance Council, Committee or Board as well as all employees.
• Coordinate and host an annual compliance and ethics fair each FY.

4) Monitoring/Auditing

• Reviews internal controls within any related business unit and makes determination as to the unit's adequacy in preventing revenue cycle and Purchased Care operational failures.
• Develops and implements evaluation and measurement tools, utilizing a variety of software applications, which may include but is not limited to Excel, Access, VSSC, ProClarity, ICB, FBCS, QuadraMed, CRTS, and RAT-STATS.
• Develops and conducts management surveys and projects to advise the organization about compliance issues that substantially impact the facility.

5) Risk Assessment

• Serves as the single resource person for providing leadership in all aspects of CBI Risk Assessment and Management processes.
• Formalize measurement tools for high-risk areas and key indicators of success that have impact on Purchased Care, authorized and non-authorized care, medical care provided under Mill Bill, ChampVA, TriCare, consolidated business operations, billing, coding accuracy, and documentation.
• Develops guidance, policies, or procedures to address identified risks for all areas facility-wide.

6) Investigation/Response

• Ensure processes and procedures for formal and informal investigations in accordance with applicable handbooks, directives, Human Resources and guidance from Regional Counsel.

7) Enforcement/Discipline

• Demonstrate adherence to prohibition of employment of individuals contained on any of the Government Sanctions List (GSL).
• Recommend training and/or discipline for employees in violation of compliance standards pursuant to the Compliance Plan in conjunction with Human Resources.

Other Duties as assigned to include these: Performs a variety of special duties requiring a high degree of managerial and analytical expertise at the request of the Director (e.g., Part-Time Physician Audits to be in compliance with OIG requirements).Work Schedule: Monday - Friday8:00am - 4:30pmTelework: Ad-hoc. VA supports the use of telework as a way to help attract and retain talented individuals in public service, increase worker productivity, and better prepare the agency to operate during emergencies. This position may be authorized for telework. Telework eligibility will be discussed during the interview process.Virtual: This is not a virtual position.Position Description/PD#: Health System Specialist (Compliance and Business Integrity Officer) / PD250580Relocation/Recruitment Incentives: Not AuthorizedCritical Skills Incentive (CSI): Not ApprovedPermanent Change of Station (PCS): Not AuthorizedRequirements 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.

QualificationsTo qualify for this position, applicants must meet all requirements by the closing date of this announcement, 01/13/2025.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-12 position you must have served 52 weeks at the GS-11. 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.Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment.You may qualify based on your experience and/or education as described below:Individual Occupational Requirements

• Undergrad 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.

Special Provision for Inservice 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.

Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-11 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: 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.

You will be rated on the following Competencies for this position:

• Compliance
• Internal Controls
• Internal Controls/Integrity

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: There are no unusual physical demands. The work is performed in an office setting. Travel to the VISN and various internal and external meetings or training is required.For more information on these qualification standards, please visit the United States Office of Personnel Management's website at EducationThere is no educational substitution at this grade level.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: 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: Additional informationThis 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.

• BenefitsA 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.Review our benefitsEligibility 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 EvaluatedYou 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.For more information on the Who may apply eligibility requirements, please refer to the OHRM Status Candidates and Other Candidate Definitions document.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.Veterans and Transitioning Service Members: Please visit the VA for Vets site for career-search tools for Veterans seeking employment at VA, career development services for our existing Veterans, and coaching and reintegration support for military service members.

• BenefitsA 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.Review our benefitsEligibility 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.
• Required DocumentsAs a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have - whether you're a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you're eligible under their policies.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 use this checklist to 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
  • DD-214/ Statement of Service
  • Disability Letter (Schedule A)
  • Disability Letter (VA)
  • Professional Certification
  • Resume
  • Separation Notice (RIF)
  • 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: When applying for Federal Jobs, eligible Veterans should claim preference for 5pt (TP), 10pt (CP/CPS/XP), or for Sole Survivor Preference (SSP) in the questionnaire. You must provide a legible copy of your DD214(s) which shows dates and character of service (honorable, general, etc.). If you are currently serving on active duty and expect to be released or discharged within 120 days you must submit documentation related to your active duty service which reflects the dates of service, character of service (honorable, general, etc.), and dates of impending separation. Additionally, disabled veterans and others eligible for 10-point preference (such as widows or mothers of eligible Veterans) must also submit an SF-15 Application for 10 Point Veteran Preference with required proof as stated on the form. Documentation is required to award preference. For more information on Veterans' Preference, please visit Feds Hire Vets - Veterans - Job Seekers - Veterans' Preference.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.
• How to ApplyAll 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 01/13/2025 to receive consideration. To preview the questionnaire click
• 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.To verify your application is complete, log into your USA JOBS account, select the Application Status link and then select the more information link for this position. The Application page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process. To return to an incomplete application, log into your USA JOBS account and click Update Application in the vacancy announcement. You must re-select your resume and/or other documents from your USA JOBS account or your application will be incomplete.Special Employment Consideration: VA encourages persons with disabilities to apply, including those eligible for hiring under 5 CFR 213.3102(u), Schedule A, Appointment of persons with disabilities [i.e., intellectual disabilities, severe physical disabilities, or psychiatric disabilities], and/or Disabled veterans with a compensable service-connected disability of 30% or more. Contact the Agency Contact for information on how to apply under this appointment authority via the Selective Placement Coordinator.The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced Federal/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 ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at 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.Agency contact informationMelonese MartinPhone 210-###-#### Email [email protected] VA Medical Center 200 Veterans Avenue Beckley, WV 25801 USNext stepsOnce 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 TransparentThe Federal hiring process is set up to be fair and transparent. Please read the following guidance.
  • Criminal history inquiries
  • Equal Employment Opportunity (EEO) Policy
  • Financial suitability
  • New employee probationary period
  • Privacy Act
  • Reasonable accommodation policy
  • Selective Service
  • Signature and false statements
  • Social security number request

Required DocumentsTo 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 use this checklist to 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
• DD-214/ Statement of Service
• Disability Letter (Schedule A)
• Disability Letter (VA)
• Professional Certification
• Resume
• Separation Notice (RIF)
• 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: When applying for Federal Jobs, eligible Veterans should claim preference for 5pt (TP), 10pt (CP/CPS/XP), or for Sole Survivor Preference (SSP) in the questionnaire. You must provide a legible copy of your DD214(s) which shows dates and character of service (honorable, general, etc.). If you are currently serving on active duty and expect to be released or discharged within 120 days you must submit documentation related to your active duty service which reflects the dates of service, character of service (honorable, general, etc.), and dates of impending separation. Additionally, disabled veterans and others eligible for 10-point preference (such as widows or mothers of eligible Veterans) must also submit an SF-15 Application for 10 Point Veteran Preference with required proof as stated on the form. Documentation is required to award preference. For more information on Veterans' Preference, please visit Feds Hire Vets - Veterans - Job Seekers - Veterans' Preference.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.How to ApplyAll 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 01/13/2025 to receive consideration. To preview the questionnaire click

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.To verify your application is complete, log into your USA JOBS account, select the Application Status link and then select the more information link for this position. The Application page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process. To return to an incomplete application, log into your USA JOBS account and click Update Application in the vacancy announcement. You must re-select your resume and/or other documents from your USA JOBS account or your application will be incomplete.Special Employment Consideration: VA encourages persons with disabilities to apply, including those eligible for hiring under 5 CFR 213.3102(u), Schedule A, Appointment of persons with disabilities [i.e., intellectual disabilities, severe physical disabilities, or psychiatric disabilities], and/or Disabled veterans with a compensable service-connected disability of 30% or more. Contact the Agency Contact for information on how to apply under this appointment authority via the Selective Placement Coordinator.The