Director, Division of Provider Enrollment Appeals

Full Job Description

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, (CPI), Provider Enrollment & Oversight Group (PEOG).

As a Supervisory Health Insurance Specialist, referred to here as the Director, Division of Provider Enrollment Appeals, GS-0107-15, you will provide day-to-day technical expertise, advice, and consultation on a range of issues aimed at identifying and addressing vulnerabilities.

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.

Your resume (limited to no more than 2 pages) 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 being considered further.

In order to qualify for the GS-15 , 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-14 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Implementing program integrity or provider enrollment related policies, procedures, or strategic plans; AND 2) Advising leadership and stakeholders on Medicare or Medicaid policy; AND 3) Supervising or leading work performed by subordinate staff or planning, organizing, or assessing the work activities of teams (e.g.

setting and adjusting short-term priorities, preparing/adjusting schedules for completion of work).

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/12885231 Major Duties:

• Supervise staff responsible for managing provider/supplier enrollment corrective action plans (CAPs) and reconsiderations for Medicare providers and suppliers whose billing privileges are denied or revoked.
• Serve as hearing officer conducting paper reviews of reconsideration requests and rendering final agency-level determinations on provider denials, revocations of billing privileges, and effective dates.
• Provide technical guidance to CMS leadership and stakeholders on provider/supplier enrollment compliance, appeals, and program integrity issues that intersect Medicare and Medicaid enrollment to prevent, detect, and deter fraud, waste, and abuse.
• Oversee cross-jurisdictional projects and studies aligned with HHS and CMS strategic goals to combat program fraud, waste, and abuse, including contract management, budget oversight, and coordination with Medicare Administrative Contractors.
• Develop and implement enrollment policies and procedures across Medicare and Medicaid programs.