U.S. Department of Labor Office of Workers' Compensation Programs
Major duties include:
- Establishes, develops, and disseminates internal control policies and procedures for the minimization of waste, fraud, and abuse. Reviews reports on internal and external controls (e.g., SOC 1&2 / SSAE 18) and implements effective relevant controls that involve reconciling output reports or files; conducting periodic discussions; and developing new strategies and integrating action plans to measure accomplishments, results, and effectiveness of the programs. Extensively analyzes and collaborates with all four programs to ensure the transition to new medical bill processing systems and the new pharmacy benefits management system underway.
- Prepares and presents reports and other materials requested by the Office of Inspector General (OIG). Assists management with any OIG investigation of improper requests for payment and improper payments. Ensures compliance with internal control procedures as it relates to Improper Payments Elimination and Recovery Act (IPERA).
- Develops audit requirements for assigned critical audit area(s) consistent with program goals and prepares written, in-depth reviews of OWCP programs and Branch assessment results and findings. Develops periodic reports and briefs analytical findings to Program Heads, DAO Director, and Deputy Director. Keeps abreast of new audit trends and developments within other programs, Federal Agencies (i.e., Centers of Medicaid and Medicare Services), and State and Federal workers' compensation programs and applies knowledge in the
development and/or recommendation of program policy and process improvements.
- Manages and maintains a library and tracking system of all audit reports that include OIG and the Government Accountability Office (GAO) to enhance transparency, audit readiness, and accountability throughout all four benefit programs. Responds to various inquiries and recommendations from internal and external stakeholders; develops corrective action strategies; and follow-ups until closure is confirmed. Coordinates the necessary corrective actions on behalf of the four programs to ensure that all systems comply with OWCP policies, procedures, and regulations.
Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level,GS-13, in the Federal Service.
Specialized Experience is the experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform the duties of the position successfully, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level.
Qualifying specialized experience includes:
- Demonstrating comprehensive knowledge of medical and pharmaceutical bill processing systems through experience in developing, writing, implementing, presenting, or educating stakeholders with respect to auditing, analysis, laws, policies, and controls that underlay workers compensation programs. These skills should be demonstrated across multiple iterations or significant involvement of the principles; AND
- Creating and institutionalizing (through culture, automation, or workflow changes) procedures, systems, measures, and audit requirements related to policy; AND
- Leading or supporting the development, implementation, and/or operations of automated bill processing solutions for pharmacy or medical operations.