Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity,Provider Compliance Group.

As a Health Insurance Specialist (Program Integrity), GS-0107-13 you will review regulatory guidance and CMS program changes; developed reporting tools to analyze data, improve compliance and efficiency, support leadership decisions, and ensure alignment with federal requirements.

Duties

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• Program Integrity Development and Implementation analyze, develop, and implement a wide range of program integrity initiatives that support CMS' lines of business through comprehensive program integrity reviews.
• Analytical Research and Special Projects apply a wide range of analytical methods and techniques to assess and improve program efficiency, effectiveness, and complex processes or systems relating to health programs.
• Legislative and Regulatory Analysis Evaluate and analyze the impact of new or revised changes to legislation before Congress pertaining to any CMS program.
• Stakeholder Engagement and Technical Assistance provide technical assistance to staff in other federal agencies, state agencies, and private sector organizations, consistent with program expertise and experience.
• Operational Requirements and Database Management produce routine and ad hoc reports, deliverables, and programmatic documentation to support program integrity operations.

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.
• 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. Identifying health insurance program vulnerabilities to detect fraud, waste, or abuse;

2. Collaborating across organizational lines in support of program integrity educational efforts, or oversight of health insurance programs; AND

3. Developing and implementing policies for program integrity stakeholder and engagement activities.

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/[redacted]

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: No

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.