This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity(CPI), Front Office (FO). As a Health Insurance Specialist, GS-0107-14, you will serve as an advisor to the Director and Deputy Directors of CPI, providing technical guidance and project management associated with developing and implementing program integrity policies and initiatives.

Duties

Identifiy vulnerabilities in program integrity initiatives related to investigation, enforcement, and deterrence of fraud, waste, and abuse that may pose legal problems for policy and operational goals. Plan and oversee the Center’s efforts on developing Medicare, Medicaid and Health Insurance Marketplaces program integrity regulations and instructions for Medicare contractors and states related to investigation, enforcement, and deterrence of FWA. Lead the development of new trainings and initiatives with the CPI Fraud Investigations Group (FIG) and other related groups to implement modern investigative methods, improve contractor oversight and alignment with Center leadership priorities. Maintain up-to-date expertise in laws, caselaw, regulations, policies, procedures, trends, and developments, both international and domestic, and their impact on the integrity of the CMS’ management of health care programs. Prepare or direct the preparation of written communications to address complex and comprehensive correspondence, memoranda, briefing papers, option papers, speeches, and program proposals for the Director and Deputy Directors.

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-14, 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: Identifying issues, options, and recommendations to advise senior management on new or existing healthcare related policies, regulations, or critical issues that may impact Agency Program Integrity (PI); AND Overseeing programs or projects designed to investigate and/or deter healthcare related (e.g. Medicare, Medicaid, Health Insurance Marketplace) fraud, waste, and abuse; AND Drafting healthcare related policies, procedures, issues papers, or training materials that communicate clearly and effectively; AND Collaborating with internal and external stakeholders on developing investigative related trainings and/or initiatives to improve PI oversight. 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/12470857

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]