Program Integrity Investigator Jobs in Boston, MA

Summary
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, Provider Enrollment & Oversight Group (PEOG).
As a Provider Enrollment Site Visit Analyst, GS-0107-9/11, the incumbent carries out compliance reviews of Medicare providers and suppliers by visiting their physical locations/worksites. This helps ensure program integrity and safeguards Medicare beneficiaries and taxpayer resources.
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Duties
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• Reviews financial payments and provider enrollment to identify fraud, waste, and abuse. Applies established methods to analyze allegations, uses protocols to assess operational issues, and conducts studies to address program vulnerabilities.
• Develops and interprets policies and regulations for program integrity. Identifies policy issues, recommends solutions, formulates conclusions that inform management decisions, and conducts studies to improve sanctions and integrity initiatives.
• Collaborates with CMS, state agencies, contractors, and providers, as well as external agencies like HHS OIG, FBI, and DOJ on FWA matters. Compiles case summaries and engages with officials across the health care sector.
• Communicates findings through briefings and reports, represents the agency at meetings, provides technical advice on program vulnerabilities, and responds to inquiries about provider enrollment and integrity issues

Requirements
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Conditions of employment

• 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.
• If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the DHS "E-Verify" System.
• All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choice.

Qualifications
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 receiving further consideration.
In order to qualify for the GS-09, 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-07 grade level in the Federal government, obtained in either the private or public sector, to include:
1. Assisting with reviews of proposed, amended, or newly implemented Medicare, Medicaid and/or Marketplace laws, regulations, and policies to assess program compliance and provide recommendations for corrective measures;
2. Supporting team by gathering information to respond to basic written, telephonic, or electronic inquiries regarding Medicare, Medicaid or Marketplace program integrity; And
3. Collaborating with internal teams, external agencies, contractors, or oversight bodies to help with investigations, audits, or compliance efforts involving health insurance programs.
- OR -
Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 level by possessing a Master's or equivalent graduate degree or 2 full years of progressively higher-level graduate education leading to such a degree or LL.B. or J.D., if related to the position being filled.
- OR -
Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-07 grade level may be used to qualify applicants for positions at grades GS-09. Therefore, only education in excess of 1 full year of graduate-level education may be used to combine education and experience.
TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the "Required Documents" section below for the documentation required at the time of application.
In order to qualify for the GS-11, 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-09 grade level in the Federal government, obtained in either the private or public sector, to include:
1.Reviewing proposed, amended, or newly implemented Medicare, Medicaid and/or Marketplace laws, regulations, and policies to assess program compliance and provide recommendations for corrective measures;
2. Responding to basic written, telephonic, or electronic inquiries regarding Medicare, Medicaid or Marketplace program integrity; And
3. Collaborating with internal teams, external agencies, contractors, or oversight bodies to help with investigations, audits, or compliance efforts involving health insurance programs; this includes writing reports.
- OR -
Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher-level graduate education leading to such a degree or equivalent doctoral degree or LL.M., if related to the position being filled.
- OR -
Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at grades GS-11. Therefore, only education in excess of a master's or equivalent graduate degree or 2 full years of progressively higher-level graduate education leading to such a degree may be used to combine education and experience.
TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the "Required Documents" section below for the documentation required at the time of application.
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/13042746
Education
TRANSCRIPTS are required to verify satisfactory completion of the educational requirement listed above. Failure to submit a copy of your transcripts at the time of application WILL result in an ineligible rating. Please see "Required Documents" section below for what documentation is required at the time of application.
Additional information
Salary Range:
Boston, MA:69,905-109,959
Seattle, WA: 69,373-109,122
Dallas TX: 67,100-105,547
Bargaining Unit Position: Yes- American Federation of Government Employees, Local 1923
Tour of Duty: Flexible
Recruitment Incentive: Not authorized
Relocation Incentive: Not authorized
Financial Disclosure: Not required
Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement. CMS offers flexible working arrangements and allows employees the opportunity to participate in alternative work schedules at the manager's discretion.
The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.
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Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution.
Benefits
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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
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Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.