Medicaid Fraud Oversight Specialist

Summary

This position is located in the Department of Health and Human Services, Office of Inspector General, Office of Evaluation and Inspections. The announcement will close at 11:59p.m. EST on the date the applicant limit has been reached which may be sooner than the closing date. Resumes must be no more than 2-pages in length.

Duties

Duties for the Medicaid Fraud Oversight Specialist, GS-0301-12 include but not limited to: Recommends comprehensive solutions to MFCU Oversight Division (MOD) director and other OIG officials that will further the purpose and objective of the MFCU grant program. Analyzes and evaluates recertification applications and other materials to ensure that MFCUs are adhering to published performance standards as well as applicable law and regulations Analyzes sources of information in support of inspections, from evidence, including databases, to establish the accuracy and authenticity of the information. Works to improve effectiveness of the MFCUs by assisting with oversight issues; identifying available resources, such as subjectexperts and data systems; and encouraging collaboration with OIG on fraud cases and other initiatives. Works on MFCU-related special assignments comprised of sensitive and/or confidential information about specific issues pertaining to Medicaid provider fraud and patient abuse or neglect and executes all aspects of the MFCU oversight process in an accurate and timely manner. Conducts periodic onsite reviews of selected MFCUs, in compliance with evaluation standards of the Council for the Inspectors General on Integrity and Efficiency (CIGIE) and prepares written reports of those reviews. Proposes recommended courses ofaction based upon the review, such as corrective action or other grant sanctions. Makes oral presentations on findings andrecommendations. In collaboration with statisticians, information technology, and other experts, collects and analyzes statistical and other pertinent data from various sources and assists with the preparation of the Annual MFCU report. Supports enhanced and targeted evaluation reviews for selected states conducted by regional off ices. Serves as the primary subject matter expert for those reviews and provides logistical and analytical support. Coordinates oversight activities as necessary with the Centers for Medicare & Medicaid Services (CMS), Administration for Community Living (ACL), and other HHS and Federal agencies. Prepares responses to Congressional and other types of correspondence and requests for information regarding MFCU matters. Represents MOD at conferences, training sessions, and meetings to disseminate information, provide technical advice, and present training on the MFCU oversight to various-sized audiences. Qualifications

You must meet the requirements of the job by 11:59 (Eastern Standard Time) of the closing date: 09/21/2026 Applicants must meet all the qualification requirements, including education, and any selective placement factors described below within 30 days of the closing date of this announcement. Minimum Qualification Requirements: Applicants MUST have 1 year of specialized experience equivalent to the GS-11 grade level in the Federal service which provided the applicant with the particular knowledge, skills and abilities to perform the duties of the position. Qualifying specialized experience demonstrates the following: (1) Experience monitoring or overseeing a federally funded or State administered healthcare program to ensure adherence to applicable laws, regulations, and performance standards (e.g., program statutes, Federal grant requirements, or regulatory criteria); (2) Experience planning, conducting, and evaluating healthcare program reviews or assessments-such as certification/recertification activities-to determine program effectiveness and recommend improvements; (3) Experience collecting, analyzing, and interpreting healthcare program or performance data from multiple sources to identify trends, assess program performance, and support data driven recommendations or reporting; (4) Experience liaising with internal and external stakeholders-such as healthcare program officials, State agencies, oversight bodies, or multidisciplinary teams-to gather information, provide guidance, negotiate solutions, and support collaborative healthcare program oversight; AND (5) Experience preparing clear, concise, and technically accurate written materials (e.g., reports, evaluations, correspondence) that communicate healthcare program findings, compliance issues, or recommendations to management or external partners. 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. Your resume should include the dates of all qualifying experience (from month/year to month/year) and the number of hours worked/volunteered per week. Federal experience is not required. The experience may have been gained in the public sector, private sector or Volunteer Service. One year of experience refers to full-time work; part-timework is considered on a prorated basis. To ensure full credit for your work experience, please indicate dates of employment by month/year, and indicate number of hours worked per week, on your resume.

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), your responses on the application questionnaire, and your responses to all assessments required for this position. You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics): Compliance Data Management Planning and Evaluating Stakeholder Management Writing Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on an assessment may also result in your removal from consideration. Please note that a complete application is required for consideration. (Please review the "Required Documents" section of this job announcement to see what must be included in a complete application). To view the application form, visit: https://apply.usastaffing.gov/ViewQuestionnaire/13056266 Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar across HHS. Other Information

Recruitment Incentives: Payment for relocation expenses will not be authorized for this position. A recruitment bonus will not be offered. Repayment of student loans will not be offered. Private sector work experience will not be approved as credit for your Annual Leave accrual. Security and Background Requirements: A background security investigation will be required for all appointees. Appointment will be subject to the applicant's successful completion of a background security investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a background security reinvestigation or supplemental investigation may be required at a later time. Applicants are also advised that all information concerning qualifications is subject to investigation. False representation may be grounds for non-consideration, non-selection and/or appropriate disciplinary action. E-Verify: 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. Federal law requires DHS to use the E-Verify System to verify employment eligibility of all new hires, and as a condition of continued employment obligates the new hire to take affirmative steps to resolve any discrepancies identified by the system. The U.S. Department of Health and Human Services is an E-Verify Participant. Direct Deposit: All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choosing. EEO Statement: HHS is an equal opportunity employer. Selection for this position will be based solely on merit without regard to race, color, religion, age, gender, national origin, political affiliation, disability, sexual orientation, marital or family status, or other differences. Disabled Veteran Leave: HHS OIG participates in the Wounded Warrior Federal Leave Act of 2015. To learn more about this benefit, please go to: Disabled Veteran Leave (opm.gov). Fair Chance to Compete for Jobs Act ("Fair Chance Act"): The Fair Chance to Compete for Jobs Act (FCA) prohibits federal agencies from requesting an applicant's criminal history record prior to extending a conditional offer of employment. In accordance with 5 U.S. Code § 9202(c) and 5 C.F.R § 920.201 certain positions are exempt from the provisions of the FCA. Applicants who believe they have been subjected to a violation of the FCA may submit a written complaint to the Department by email at [email protected]. HHS has a critical preparedness and response mission: HHS protects the American people from health threats, researches emerging diseases, and mobilizes public health programs with domestic and international partners. In support of this mission, HHS offers its employees the opportunity to volunteer to become Federal Civilian Detailees and contribute their unique skills through voluntary temporary assignments to humanitarian emergencies or Departmental priorities countering new and emerging health, safety, and security threats.