This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), Division of Prescription Drug Audits. As a Health Insurance Specialist (Program Integrity), GS-0107-11/12, you will analyze, develop, and implement a wide range of program integrity initiatives that support CMS' lines of business through comprehensive program integrity reviews.

Duties

Independently review and evaluate financial program payments, investigate fraud, waste, and abuse allegations, conduct program integrity reviews, and study financial systems. Analyze, develop, implement, and modify operating policy and procedures relating to program integrity. Provide technical assistance to stakeholders (e.g., Medicare, Medicaid, and/or private insurance that provide health care and drug services, and Providers), on CMS requirements. Prepare a variety of written products, including position papers and briefing materials for senior officials to use as background information on program integrity related activities.

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.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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-11, 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-09 grade level in the Federal government, obtained in either the private or public sector), to include: Compiling data to assist in identifying fraud, waste, or abuse in the Medicare Part C and/or Part D program. Collaborating across organizational lines on investigations, audits, or oversight of program integrity contractors. Researching Medicare Part C and/or Part D statutes or guidance to report basic program issues. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher level graduate education leading to such a degree or equivalent doctoral degree or LL.M., if related to the position being filled. (TRANSCRIPTS REQUIRED AT TIME OF APPLICATION). - OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at the grade GS-11. Therefore, only education in excess of a master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree, may be used to combine education and experience. (TRANSCRIPTS REQUIRED AT TIME OF APPLICATION). TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see "Required Documents" section below for what documentation is required at the time of application. In order to qualify for the GS-12, 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-11 grade level in the Federal government, obtained in either the private or public sector, to include: Reviewing Medicare Part C and/or Part D health insurance program vulnerability studies to detect fraud, waste, or abuse. Collaborating across organizational lines on Medicare Part C and/or Part D investigations, audits, or oversight of program integrity contractors. Researching Medicare Part C and/or Medicare Part D health care trends to identify how they may impact current policy. Substitution of Education for Experience: There is no substitution of education to meet the specialized experience requirement at the GS-12 grade level. Combination of Experience and Education: There is no combination of experience and education to meet the specialized experience requirement at the GS-12 grade 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; 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. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12348556

Contacts

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