This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, (CPI), Fraud Investigations Group. As a Health Insurance Specialist, GS-0107-12, you will develop policies and initiatives regarding program integrity in Medicaid managed care.

Duties

Serves as a Health Insurance Specialist in the development, implementation, and evaluation of federal policies, guidance, and oversight initiatives regarding program integrity in Medicaid managed care. Analyzes, develops, implements, and modifies operating policy and procedures relating to program integrity in Medicaid managed care. Establishes rapport with partnering CMS components, as well as internal and external stakeholders to the organization on issues of a sensitive or critical nature to address evolving Medicaid managed care program issues. Prepares 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.
• You may be required to serve a 1 year probationary period.

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-12 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-11 grade level in the Federal government, obtained in either the private or public sector, to include: Assist in developing, drafting and implementing policies, guidance, and oversight initiatives regarding program integrity in Medicaid managed care. Evaluate and assist in developing regulations and sub regulatory guidance, training, and technical assistance for state Medicaid agencies regarding high-risk areas of Medicaid managed care policies and processes. Establish and maintain working relationships with partnering organizations, as well as internal and external stakeholders to the organization on issues of a sensitive or critical nature to address evolving Medicaid managed care program issues. 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/12618373

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]