Provider Enrollment Site Visit Analyst

• Reviews financial payments and provider enrollment to identify fraud waste and abuse. Applies established methods to analyze allegations uses protocols to assess operational issues and conducts studies to address program vulnerabilities.
• Develops and interprets policies and regulations for program integrity. Identifies policy issues recommends solutions formulates conclusions that inform management decisions and conducts studies to improve sanctions and integrity initiatives.
• Collaborates with CMS state agencies contractors and providers as well as external agencies like HHS OIG FBI and DOJ on FWA matters. Compiles case summaries and engages with officials across the health care sector.
• Communicates findings through briefings and reports represents the agency at meetings provides technical advice on program vulnerabilities and responds to inquiries about provider enrollment and integrity issues

• 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.
• 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.

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 receiving further consideration.

In order to qualify for the GS-09 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-07 grade level in the Federal government obtained in either the private or public sector to include:

1. Assisting with reviews of proposed amended or newly implemented Medicare Medicaid and/or Marketplace laws regulations and policies to assess program compliance and provide recommendations for corrective measures;
2. Supporting team by gathering information to respond to basic written telephonic or electronic inquiries regarding Medicare Medicaid or Marketplace program integrity; And
3. Collaborating with internal teams external agencies contractors or oversight bodies to help with investigations audits or compliance efforts involving health insurance programs.

- OR -

Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 level by possessing a Masters or equivalent graduate degree or 2 full years of progressively higher-level graduate education leading to such a degree or LL.B. or J.D. if related to the position being filled.

- OR -

Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-07 grade level may be used to qualify applicants for positions at grades GS-09. Therefore only education in excess of 1 full year of graduate-level education may be used to combine education and experience.

TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the Required Documents section below for the documentation required at the time of application.

In order to qualify for the GS-11 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-09 grade level in the Federal government obtained in either the private or public sector to include:

proposed amended or newly implemented Medicare Medicaid and/or Marketplace laws regulations and policies to assess program compliance and provide recommendations for corrective measures;
2. Responding to basic written telephonic or electronic inquiries regarding Medicare Medicaid or Marketplace program integrity; And
3. Collaborating with internal teams external agencies contractors or oversight bodies to help with investigations audits or compliance efforts involving health insurance programs; this includes writing reports.

- OR -

Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher-level graduate education leading to such a degree or equivalent doctoral degree or LL.M. if related to the position being filled.

- OR -

Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at grades GS-11. Therefore only education in excess of a masters or equivalent graduate degree or 2 full years of progressively higher-level graduate education leading to such a degree may be used to combine education and experience.

TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the Required Documents section below for the documentation required at the time of application.

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.



Click the following link to view the occupational questionnaire: are required to verify satisfactory completion of the educational requirement listed above. Failure to submit a copy of your transcripts at the time of application WILL result in an ineligible rating. Please see Required Documents section below for what documentation is required at the time of application.