This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), Audits and Vulnerabilities Group. As a Health Insurance Specialist (Program Integrity), GS-0107-13, you will be responsible for analyzing, developing, and implementing a wide range of program integrity initiatives that support CMS' lines of business.

Duties

Serve as an expert in the development, evaluation, and implementation of policies related to program integrity initiatives regarding Medicare, Medicaid, Children’s Health Insurance Program (CHIP), and Marketplace/Exchanges. Evaluate, develop, and implement improvements to program integrity to deter, reduce, and eliminate fraud, waste, and abuse. Develop and review health care policies and legislation in order to draft related policy documents, regulations, procedures and guidance to states. Act as an Agency representative and contributes to discussions and planning sessions on program policy developments.

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-13 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-12 grade level in the Federal government, obtained in either the private or public sector, to include: Participating in Medicare, Medicaid, or Marketplace program integrity audits or fraud investigations; and Lead the development, execution and oversight of high-priority audits or fraud investigations; and Perform analyses of operational fraud policy and program operations. 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/12479487

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]