The Affordable Care Act (ACA) requires every state to establish a health insurance exchange (also called Health Insurance MarketplaceSM) to facilitate the purchase of health insurance for individuals and small businesses. Through the Center of Program Integrity (CPI), CMS has strong oversight and internal controls to protect consumers enrolled in the Marketplaces and safeguard taxpayer dollars. CMS develops and enforces rules for insurance agents, and brokers and others who assist with FFM enrollments. The Marketplace Program Integrity Contractor (MPIC) is designed to support this oversight. Through research, investigation and data analysis, the desired outcomes of the MPIC efforts are to prevent, detect, and resolve noncompliance with Marketplace rules, requirements, and laws; recommend administrative action to CMS; and recommend referral to law enforcement if potential fraud and abuse is identified.
As part of a new and evolving program, the CSRA Team will establish and build relationships with other governmental agencies and will attend events sponsored by other entities who have a vested interest in the integrity of the Marketplace, many of whom do not have the resources that CMS has available to help them in their oversight roles. Those multiple agencies and events fall on a wide spectrum, including, but not limited to:
- Office of Inspector General (OIG)
- Federal Bureau of Investigation (FBI)
- Department of Justice (DOJ)
- United States Attorney’s Office (USAO)
- State Attorney General
- Internal Revenue Service
- Postal Inspector
- State Department of Insurance
- Large Insurers
- Local Law Enforcement Task Force Meetings
- National Association for Medicaid Program Integrity
- Association of Certified Fraud Examiners (ACFE)
- A wide variety of private health plans and issuers, e.g. Kaiser Permanente
The Engagement-Outreach Coordinator will develop and enhance the MPIC Engagement-Outreach Strategy and Plan and manage its implementation while working closely with CSRA MPIC managers and leads.
Specific responsibilities include.
Constantly Update the Engagement-Outreach Plan that will:
- Emphasize ensuring compliance through Education, Outreach, and Training by creating profiles of Marketplace actors to identify those whose behaviors are outliers and targeting them for outreach and education
- Establish a working group for groups with a vested interest in Marketplace Program Integrity to share ideas, tools, techniques, lessons learned and best practices
- Recruit partners to the Workgroups to aid in detecting and preventing FWA
- Emphasize data sharing among workgroup partners where appropriate to further educate consumers and partners in avoiding FWA
- Assist in the development reports that provide added-value to workgroup partners
- Build upon the decades of CMS program integrity efforts to leverage existing tools, techniques, and processes that the investigator community is accustomed to
- Lead the development of marketing materials as needed to further the process
- Assist in the development of training for select staff in the engagement-outreach process
- Closely monitor and regularly document the progress made in the engagement-outreach process and make recommendations for improvement as needed.
- Reports to and meet regularly with the Project Director providing weekly status updates on engagement-outreach status and activities
- Meet regularly with MPIC Task teams and managers as needed to update them and resolve any ongoing questions.
- BS/BA or equivalency
- 3-6years’ experience in ACA activities
- 5+ years’ experience in leading outreach and/or marketing activities as well as in developing engagement-outreach strategies with emphasis on healthcare issues
- Highly, organized, ability to multi-task and meet deadlines
- Proficient in computer skills, e.g. Microsoft Office-Word, Excel
- Strong inter-personal and communications skills, both written and oral
- Ability to identify needed improvement in processes and make recommendations
- Anticipated Start Date: 10/23/17
- MPIC – 1 BY and 4 OYs
- FT Position
- Location – CSRA Rockville Office/Some Teleworking permitted
- Reports to Project Director
CSRA is an Equal Opportunity Employer and all Qualified Applicants will receive consideration for employment without regard to Race, Color, Religion, Sex, National Origin, Disability Status, Protected Veteran Status or any other Characteristic Protected by Law.