Provider Enrollment Site Visit Analyst

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, Provider Enrollment & Oversight Group (PEOG). As a Provider Enrollment Site Visit Analyst, GS-0107-9/11, the incumbent carries out compliance reviews of Medicare providers and suppliers by visiting their physical locations/worksites. This helps ensure program integrity and safeguards Medicare beneficiaries and taxpayer resources.

Duties

• 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

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 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 Master's 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: 1.Reviewing 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 master's 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: https://apply.usastaffing.gov/ViewQuestionnaire/13042746

Education

TRANSCRIPTS 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. How You Will Be Evaluated

You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), the responses you provide on the application questionnaire, and the results of the online assessments required for this position. A Subject Matter Expert may assist in the resume review process to help determine whether you meet the minimum job qualifications. Please follow all instructions carefully. Errors or omissions may affect your rating. You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics): Attention to Detail Flexibility Integrity/Honesty Interpersonal Skills Reading Comprehension Self-Management Stress Tolerance Teamwork In order to be considered for this position, you must complete all required steps in the process. In addition to the application and application questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job. The assessment includes a cut score based on the minimum level of required proficiency in these critical general competencies. You must meet or exceed the cut score to be considered. You will not be considered for the position if you score below the cut score or fail to complete the assessment. Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on the online assessment may also result in your removal from consideration. RPL ApplicantsRPL applicants who are verified as registered for the same series, grade, and location as this vacancy announcement will be placed in one of the following categories based on category rating procedures: Best Qualified - significantly exceeds the evaluation criteria Well Qualified - excelsin the evaluation criteria Qualified - meets the minimum qualification requirements If you are found to be among the top-qualified candidates, you will be referred to the selecting official for employment consideration.The category rating process does not add veterans' preference points but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans' preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher). Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on the online assessment may also result in your removal from consideration. Other Information

Salary Range: Boston, MA:69,905-109,959 Seattle, WA: 69,373-109,122 Dallas TX: 67,100-105,547 Bargaining Unit Position: Yes- American Federation of Government Employees, Local 1923 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.