Medical Advisor

Summary

This is a permanent position in the Civil Fraud Section, which pursues health care fraud cases under the False Claims Act. These positions will support a significant expansion of the data, research, and analytics team in the Fraud Section. They require clinical, public health, and coding expertise to advise the data team and attorneys of the most likely potential fraud areas based on observable data patterns in light of the incumbent's medical expertise.

Duties

The duties and responsibilities for a GS-0601-15 Medical Advisor generally include, but are not limited to, the following: Providing expert advice of relevant medicine, public health, and health care financing programs (with special emphasis on Medicare), coding, and methods to prevent and detect fraud and abuse. Locating and reviewing medical literature and other medical and pharmacological information. Reviewing information provided to Department staff on case matters by defendants and others to corroborate the accuracy of any medical content included. Reviewing and analyzing medical records and presenting findings, either orally or in written reports. Providing medical representation for the Department of Justice at meetings relevant to health care fraud, as requested by management. Preparing oral and written presentations on medical and program policy issues as requested. Providing guidance to Department attorneys and staff in connection with Medicare and Medicaid billing codes. Recommending and proposing investigative steps or focus areas based upon review, from medical, clinical, or payor policy perspective, of health care data analysis. Preparing written recommendations and proposals with detailed rationale drawing on review of data analysis conducted by Civil Division, and distilling medical, clinical, and payor policy expertise into proposals.

Qualifications

To qualify for the position of Medical Advisor, at GS-0601-15, you must meet the qualification requirements listed below. Candidates must possess the following basic requirements to receive consideration for this position: 1) A Bachelor's or graduate/higher level degree: major study in an academic field related to the medical field, health sciences or allied sciences appropriate to the work of the position. In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. To qualify for the GS-15 position, you must have at least one full year of specialized experience equivalent to the GS-14 level in the Federal service assisting in health care fraud prevention, detection, and enforcement by providing advisement on relevant medicine, coding, public health, and health care financing programs. Conducting coding assessment and/or reviews of clinical procedures. Conducting assessment, research, or advisement on Medicare coverage requirements. Advising on Medicare policies and/or whether certain items or services are rendered consistent with those requirements/policies. Providing medical guidance and technical support in conceiving and conducting health care fraud investigations and enforcement actions. Analyzing medical, clinical, or health care claims data. Conducting medical, clinical, or coding research to provide advice to investigative teams conduct reviews of medical records and presents the findings. You MUST meet all qualification requirements by the close of this announcement. Your resume must support your responses to the online questionnaire and the qualification requirements. Failure to do so may result in an ineligible rating.

Education

This position has a basic education requirement consisting of a Bachelor's or graduate/higher level degree in a major academic field or study related to the medical field, health sciences or allied sciences appropriate to the work of the position. If you are relying on your education to meet qualification requirements, please see the statements below. Education must be reviewed and certified by an accrediting institution recognized by the U.S. Department of Education, in order for it to be creditable towards your qualifications. Therefore, provide only the attendance and/or degrees from accredited institution. FOREIGN EDUCATION: Education completed in foreign colleges or universities may be used to meet the requirements. You must show proof the education credentials have been deemed to be at least equivalent to that gained in a conventional U.S. education program. It is your responsibility to provide such evidence when applying. For special instructions pertaining to foreign education and a list of organizations that can evaluate foreign education, see the Department of Education website. If you are qualifying on foreign education, you MUST submit proof of creditability of education as evaluated by a credentialing agency. Transcripts must be uploaded with your application to verify education. All documentation must be in English or include an English translation.