Health Insurance Specialist

Centers for Medicare & Medicaid Services•Woodlawn, MD

12d

About The Position

This position is in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI). As a GS-0107-14 Health Insurance Specialist, you will advise the CPI Director and Deputy Directors and provide technical guidance and staff-level project management for developing and implementing program integrity policies and initiatives. The role involves addressing healthcare policy issues affecting Medicare and Medicaid spending, coordinating high-priority projects with government and external partners, and representing CMS in meetings focused on preventing healthcare fraud. You will analyze trends and issues affecting Medicare, Medicaid, and CHIP and prepare written materials to inform senior officials and federal healthcare decisions.

Requirements

Be a U.S. Citizen or National.
Meet applicable time-in-grade restrictions; current Federal employees must have at least 52 weeks at the next lower grade.
Have at least one year (52 weeks) of specialized experience equivalent to the GS-13 grade level, including leading or coordinating cross-cutting Medicare and/or Medicaid program integrity projects or initiatives across CMS components or with external entities.
Have experience analyzing Medicare and/or Medicaid laws, regulations, policies, or program data to identify vulnerabilities and determine their impact on program integrity operations, including fraud, waste, and abuse prevention or detection.
Have experience developing written products, such as briefing papers, memoranda, or policy or option papers, to advise senior officials on program integrity issues.
Meet all qualification requirements within 30 days of the announcement closing date.
Submit a resume of no more than two pages that documents relevant responsibilities and specialized experience.
Undergo a background and suitability investigation.
Males born after December 31, 1959, must be registered or exempt from Selective Service.
A one-year probationary period may be required.
If selected, have employment eligibility documentation verified through the DHS E-Verify system.
Receive Federal salary payments by direct deposit.

Responsibilities

Advise the Center for Program Integrity Director and Deputy Directors on critical healthcare policy issues affecting Medicare and Medicaid spending.
Provide technical guidance and staff-level project management for developing and implementing program integrity policies and initiatives.
Lead and coordinate high-priority projects involving multiple government agencies, Congressional offices, and healthcare industry partners.
Represent CMS in meetings with Congress, federal agencies, state governments, and healthcare industry leaders to build partnerships focused on preventing healthcare fraud.
Analyze emerging healthcare-sector trends and issues that could affect Medicare, Medicaid, and CHIP programs.
Develop written materials, including policy recommendations and executive briefings, to inform major federal healthcare decisions.