Medicare/Medicaid Program Integrity Advisor

USmax Corporation•Remote, US,

2d•$125,000 - $144,000•Remote

About The Position

USmax is seeking a Medicare/Medicaid Program Integrity Advisor for the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), and the Center for Program Integrity (CPI). This role will support events, e-learning curriculum, and course development. This includes developing and updating educational and outreach materials (courses, tools, fact sheets, etc.) for fraud, waste, and abuse (FWA), and analyzing and identifying education and outreach opportunities to address vulnerabilities and known fraud schemes within CMS programs. The Medicare/Medicaid Program Integrity (PI) Advisor will ensure quality and compliance with current CMS guidance and regulations.

Requirements

Proficient in Microsoft Office Applications (Microsoft Outlook, Word, Excel, PowerPoint, and SharePoint); advanced knowledge of Excel formulas preferred
Excellent verbal and written communication and presentation skills
Ability to proactively anticipate project needs, support project strategy and implementation
Organized, detail-oriented, self-motivated, efficient, flexible, and able to meet deadlines
Experience executing in a high-paced, evolving environment with short deadlines
Ability to comprehend and provide analysis of deliverables and related customer-facing materials
Ability to demonstrate sound judgment, attention to detail, and critical thinking
Ability to work independently
5 years minimum experience supporting Medicare, Medicaid, or healthcare Program Integrity initiatives
Thorough understanding of CMS Program Integrity regulations, Medicare and Medicaid guidance, policy directives, and related federal requirements
Demonstrated expertise in CMS Program Integrity operations and policy

Nice To Haves

Seven to ten years supporting CMS CPI initiatives
Five years reviewing policy and regulatory guidance

Responsibilities

Perform a thorough review of peer submissions to ensure submission quality and compliance with current CMS guidance and regulations
Serve as the Program Integrity subject matter expert and provide guidance on CMS PI-related questions and initiatives
Stay current with emerging CMS PI guidance, industry expectations, and standards, and demonstrate the ability to translate these into educational materials for CPI stakeholders
Research and interpret CMS regulations, guidance, manuals, and policy updates
Provide expert consultation regarding Program Integrity initiatives
Review educational content for technical accuracy
Identify emerging fraud schemes and vulnerabilities
Recommend outreach and training strategies
Participate in stakeholder meetings and workgroups
Support development of fact sheets, toolkits, webinars, and training products
Other duties as assigned