This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI). As a Health Insurance Specialist, GS-0107-13, you will analyze, develop, and implement a wide range of program integrity intitiatives that support CMS' lines of buiness through comprehensive program integrity reviews.

Duties

Lead tasks designed to develop, evaluate, and implement a wide range of program integrity initiatives and reviews to support CMS’ lines of business. Evaluate, develop, and implement improvements to program integrity to deter, reduce, and eliminate fraud, waste, and abuse. Review and comment on new or proposed policy revisions, regulations, administrative sanctions and legislation to determine their impact on contractor or provider operations, and the effect on safeguarding the Agency programs. 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.
• 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-13 , 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: Evaluating health insurance program vulnerabilities to detect fraud, waste, or abuse; AND Collaborating across organizational lines on investigations, audits, or oversight of health insurance programs; AND Proposing policy changes relating to program integrity. 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/12598857

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]