Health System Specialist (Compliance and Business Integrity Officer)

Health System Specialist (Compliance and Business Integrity Officer)

Department: Department of Veterans Affairs

Location(s): San Diego, California

Salary Range: $101234 - $156498 Per Year

Job Summary: This position is located in the Department of Veterans Affairs (VA), Veterans Health Administration (VHA), San Diego VA Medical Center, in the Office of the Director. VHA's Compliance and Business Integrity (CBI) Program was established by the Under Secretary for Health in alignment with industry standards and trends to provide oversight to the VHA revenue cycle financial and business operations.

Major Duties:

• The primary purpose of this position is to provide support to health care management officials by analyzing, evaluating, advising on and/or coordinating health care delivery systems and operations. The positions renders advice on operational policies and assures these policies and assures these policies are coordinated with, and in support of, field operations. Dramatic changes in VHA's business practices such as expansion of revenue cycle financial transactional activities, expansion of purchased care activity from non-VHA industry providers, and HHS OIG-defined health care industry oversight expectations, provided the primary impetus for implementing a standardized internal compliance program. The Compliance Officer serves as a role model for ethical behavior and promotes an awareness of moral principles consistent with the mission, vision and values of the organization and those required by federal law. Duties include but are not limited to: The incumbent functions as the primary liaison to multiple staff offices and serves as the conduit for information flow and management of assignments between such offices. Monitors and manages incoming actions and requests from initial receipt to completion and closeout. Analyzes the subject matter of incoming information for appropriate distribution to offices internal and external to the office. The Compliance Officer provides guidance and counsel on incorporating compliance­ related activities into operations areas. It is the incumbent's responsibility to instill the elements of the Office of Inspector General's model compliance plan into the VHA Compliance program. Distribute written policies and procedures that promote commitment to compliance and address specific areas of potential fraud, such as billing, collections, and coding. Performs an annual system wide prioritized risk assessment, develops and/or provides effective education and training programs for all affected employees to mitigate identified risks, develops and/or performs auditing and monitoring of identified risk areas, including newly identified risks throughout the year; assists service lines departments in developing appropriate monitoring and auditing processes that mirror facility goals. Maintenance of a process, such as a helpline, to receive complaints, and the adoption of procedures to protect the anonymity of complainants. Maintains high visibility and an open-door policy to encourage employees to report potential compliance issues. Conducts investigation and remediation of system problems identified through the helpline, employee and patient communications, and interaction with professional counterparts. Develops policies addressing the non-employment or retention of sanctioned individuals. Responds and takes appropriate action to allegations of improper/illegal activities and regulations, or federal health care program requirements. Develops, coordinates and/or conducts audits and/or other evaluation techniques to monitor compliance and to assist in the reduction of identified problem areas. Reviews periodic reports with senior management detailing compliance initiatives throughout the year and recommends changes and improvements to the VA San Diego CBI program and operational compliance related activities. Analyzes audit results, develops educational tools to address audit findings, and recommends system changes, as appropriate. Manages and coordinates of all online communication tools such as assigned intranet, websites, internal SharePoint website collection, and other related informational tools in consultation with communication specialists. Assures compliance with all applicable policies, and development and maintenance of internal management processes related to these online tools. Work Schedule: Monday through Friday, 8:00 am to 4:30 pm Position Description Title/PD#: Health System Specialist (Compliance and Business Integrity Officer)/PD12969A and PD12957A Physical Requirements: Physical demands required are essentially non-strenuous and include prolonged sitting, occasional extended mobility to various areas of the facility, standing, bending and the incumbent may be required to lift light office items and files not exceeding 25 lbs. The work environment involves normal everyday risks and discomforts of office settings. The work area is lighted, heated and ventilated. Coordination and participation in meetings and other activities require presence in a variety of in-house and off-station areas and facilities. The work does include high stress with frequent abrupt deadlines. Promotion Potential: The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met. Selection at a lower grade level does not guarantee promotion to the full performance level.

Qualifications: To qualify for this position, applicants must meet all requirements by the closing date of this announcement. The Occupational Series 0671 includes an Individual Occupational Requirement (IOR). Candidates may not hold a position in this series without meeting one of the IOR requirements established by OPM. Undergraduate or graduate education in a major field of study hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. OR, Specialized 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. OR, Successful completion of an agency-sponsored on-the-job training program, 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. In addition to meeting the IOR, you may qualify based on your specialized experience as described below: You may qualify based on your experience as described below: GS-12 grade level: One year of specialized experience (equivalent to the GS-11 grade level in the federal service); experience that equipped the applicant with the particular knowledge, skills and abilities (KSA's) and other characteristics to perform successfully the duties of the position, and that is typically in or related to the work of the position to be filled, in the normal line of progression for the occupation in the organization. Specialized experience includes: 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 Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement. At this level, applicants would have obtained this experience working within a health care setting, working directly with health care system administration and finance services to solve problems in support of policy compliance and program/operational functions; experience with disbursement agreement (DA) administration used for payment of salary and benefit; and completing record data analysis to determine potential or actual fraud, waste and abuse, and to recommend redistribution of resources. GS-13 grade level: One year of specialized experience (equivalent to the GS-12 grade level in the federal service); experience that equipped the applicant with the particular knowledge, skills and abilities (KSA's) and other characteristics to perform successfully the duties of the position, and that is typically in or related to the work of the position to be filled, in the normal line of progression for the occupation in the organization. Specialized experience includes: 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 Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement. At this level, applicants would have obtained this experience working within a health care setting, working directly with health care system administration and finance services to solve problems in support of policy compliance and program/operational functions; experience with disbursement agreement (DA) administration used for payment of salary and benefit; and completing record data analysis to determine potential or actual fraud, waste and abuse, and to recommend redistribution of resources. There is no educational substitution for the GS-12 and GS-13 level. 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.

How to Apply: All applicants are encouraged to apply online. To apply for this position, you must complete the occupational questionnaire and submit the documentation specified in the Required Documents section. The complete application package must be submitted by 11:59 PM (EST) on 12/11/2025 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/12833600. 1. To begin, click Apply Online to create a USAJOBS account or log in to your existing account. Follow the prompts to select your USAJOBS resume and/or other supporting documents and complete the occupational questionnaire. 2. 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. 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. To return to an incomplete application, log into your USAJOBS account and click Update Application in the vacancy announcement. You must re-select your resume and/or other documents from your USAJOBS account or your application will be incomplete.

Application Deadline: 2025-12-11