Summary
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 integrity initiatives that support CMS' lines of business (e.g. Medicare, Medicaid and Children's Health Insurance Program (CHIP), Marketplace Exchange/Private Health Insurance, and Providers) through comprehensive program integrity reviews.
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Duties
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- Analyze, develop and implement program integrity initiatives across Medicare and Medicaid programs.
- Review payments and investigate fraud, waste and abuse allegations.
- Serve as an expert on program integrity policies and provide guidelines to internal and external stakeholders.
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.
- Selective Service: Males born after December 31, 1959, must be registered or exempt from Selective Service - http://www.sss.gov
- One-year probationary period may be required
- 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 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) Advising stakeholders on Medicare or Medicaid provider payment suspension and revocation processes, policies, or regulations.
(2) Collaborating across organizational lines on program integrity initiative or projects; and
3) Drafting, reviewing, or coordinating written responses to congressional inquiries, attorney correspondence, or other high-profile stakeholder communications.
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/12995236
Education
This job does not have an education qualification requirement.
Additional information
Salary Ranges:
Atlanta, GA: $112,556 - $146,325
Philadelphia, PA: $117,284 - $152, 471
Woodlawn, MD: $121,785 - 158,322
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: 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.