This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, Division of Provider Investigations. As a Health Insurance Specialist, GS-0107-14, you will serve as the Division's Senior Business Function Lead providing technical expertise on provider fraud, waste, and abuse in the Medicare fee-for-service (FFS), Medicare Advantage, and Medicare prescription drug programs.

Duties

Serves as an authoritative spokesperson and technical expert within FIG, CPI, and other CMS components, as a subject matter expert on Medicare fee-for-service (FFS) provider fraud, waste, and abuse investigations and UPIC policies and procedures. Lead the development, execution and oversight of high-priority Medicare fraud investigations and emerging fraud schemes. Serves as a resource person for Business Functional Leads (BFLs) for the UPICs within the Division as well as for CPI, CMS, HHS, and congressional staffs within the assigned areas of responsibility. Prepares written communications on correspondence, memoranda, papers, speeches, and program proposals for the Director/ Deputy Director to use at internal/external meetings such as CPI, OA, HHS, OIG, Congressional, and law enforcement meetings.

Requirements

• You must be a U.S. Citizen or National to apply for this position.
• You will be subject to a background and suitability investigation.
• Time-in-Grade restrictions apply.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration. In order to qualify for the GS-14 grade level , you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-13 grade level in the Federal government, obtained in either the private or public sector, to include: Technical expert on Medicare fee-for-service (FFS) provider fraud, waste, and abuse investigations, and UPIC policies and procedures. Lead the development, execution and oversight of high-priority Medicare fraud investigations and emerging fraud schemes. Served as a Business Functional Lead (BFL) for the UPICs regarding program integrity activities related to Medicare FFS. Preparation of briefings and reports for senior leadership to use at internal and external meetings such as CPI, OA, HHS, OIG, Congressional, and law enforcement stakeholder meetings. 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; religious; 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. Time-in-Grade: To be eligible, current Federal employees must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12305726

Education

This job does not have an education qualification requirement.

Contacts

• Address Center for Program Integrity 7500 Security Blvd Woodlawn, MD 21244 US
• Name: CMS HR Inquiries
• Email: [email protected]