Program Integrity Analyst (Health Insurance)

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) or Center for Consumer Information and Insurance Oversight (CCIIO).

As a Health Insurance Specialist (Program Integrity), referred to here as Program Integrity Analyst (Health Insurance), GS-0107-13, you will develop, evaluate, and implement a wide range of program integrity initiatives and reviews to support CMS' lines of business.

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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-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: 1) Evaluating health insurance program vulnerabilities to detect fraud, waste, or abuse; 2) Collaborating across organizational lines on investigations, audits, or oversight of health insurance programs; AND 3) 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.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12870273 Major Duties:

• Review and evaluate financial program payments, identify areas of potential non-compliance, investigate fraud, waste, and abuse allegations, and conduct thorough program integrity reviews to safeguard Agency programs.
• Review and comment on new or proposed policy revisions, regulations, administrative sanctions, and legislation to determine their impact on contractor/provider operations and program safeguarding effectiveness.
• Study healthcare financing or delivery systems data and conduct complex analytical projects involving coordination across organizational lines.
• Establish and maintain effective working relationships with diverse contacts including State officials, government agency representatives, and healthcare industry officials.
• Apply extensive knowledge of Titles XVIII and XIX of the Social Security Act, healthcare laws (including Title XVII of the Public Health Service Act), and regulations to make recommendations for improving program operations.