Decision Review Officer

Summary

This position is located in a Department of Veterans Affairs, Seattle Regional Office (VARO), Disability Rating Activity Section (DRAS). The Rating Quality Review Specialist is an integral part of the RO's quality assurance program, and is a key technical adviser to the Decision Review Officers (DROs) and Rating Veterans Service Representatives (RVSRs), in the Regional Office.

Duties

The purpose of this position is to measure individual performance quality and identify training needs through the review and assessment of completed claims involving appeals and rating decisions.

Major Duties:

• The Rating/Appeals Quality Review Specialist is responsible for performing quality reviews for the individual DROs and RVSRs in accordance with an established monthly schedule. Results of station reviews will indicate the appeals and rating quality level for the station. Some of the cases reviewed for the station will be subject to Central Office STAR review. The Rating/Appeals Quality Review Specialist performs individual quality reviews to determine the appeals and rating quality level of individual DROs and RVSRs for purposes of individual performance standards. The STAR worksheet will be used for both reviews.
• The incumbent tracks and analyzes all appeals and rating quality exceptions for the station and for individuals, to include exceptions called by Central Office. The Rating/Appeals Quality Review Specialist is responsible for sharing authorization quality trend information with management on an ongoing basis and with the DROs and RVSRs during training sessions. The individual develops reports and discusses report findings with the Veterans Service Center Manager, Coaches, and employees on a routine basis. Maintains secure records showing the cases reviewed and the types and number of errors found as required by the performance standards.
• The incumbent reviews products or activities for quality of performance and enters the results into the on-line STAR checklists. Evaluates and identifies deficiencies of all elements of a claim from evidence development, through rating and appeal decisions. Provides an explanation of errors and includes comments where attention is warranted. Returns completed claims called in error to the originating DRO or RVSR for correction. The outcome of reviews is to improve performance especially in accuracy, timeliness and customer satisfaction. When warranted, assists the Coach in conducting expanded reviews if individual performance is found to be deficient.
• Interacts with supervisory personnel through discussion of individual claims that have been reviewed. Explains rationale and provides appropriate citation to support an error call. As determined by local union and management agreement, may provide feedback to the DRO or RVSR. Prepares STAR data reports and provides to personnel in the regional office who are authorized to request and receive such reports. Performs administrative functions (i.e., providing feedback on reviews and maintaining reports).
• Utilizes STAR review results and identified trends to recommend training for Decision Review 5%
  
  Officers and Rating Veterans Service Representatives. Analyzes available data which reflects quality levels to determine training needs of new DROs and lower-graded RVSRs. The Rating/Appeals Quality Review Specialist will also work collaboratively with the Authorization Quality Review Specialist to identify overall station trends and training needs, primarily in the development portion of claims processing where there is considerable overlap.
• Prepares and conducts formal training sessions; including but not limited to training for newly hired personnel, refresher training and other necessary training due to changes in procedures, regulations, or the law.
• The incumbent provides assessments to the first-line supervisor detailing strengths and weaknesses observed in the trainees and identify ways for improvement in performance. He/she provides periodic assessments to division management on the quality of the work produced by all authorization personnel, including trainees. The incumbent develops methods for mentoring members of the team on the technical aspects of the job in a manner which addresses individual learning needs and effectively offers feedback to identify and correct deficient areas.
• Performs in-depth research, analyzes operating contingencies and special situations. Assists technical managers and staff in developing claims processing solutions. Conducts statistical analysis of STAR reviews to identify trends in quality, significant problems areas and processes requiring improvement. Performs quality management activities that are designed to improve quality of case processing. Monitors qualitative and quantitative measurements to identify quality program trends. Identifies areas requiring further analysis.

Work Schedule: 7:30AM-4:00PM

Compressed/Flexible: Available

Telework: Yes - as determined by the agency policy

Virtual/Remote: This is NOT a virtual/remote position

Position Description/PD#: Decision Review Officer (RQRS) 37138A

Relocation/Recruitment Incentives: Not Authorized

Financial Disclosure Report: Not Required

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