USAJOBS · 16 hours ago
Program Integrity Analyst (Health Insurance)
Multiple Locations, USA
Full-time
Hybrid
Mid, Senior Level
$91K/yr - $118K/yr
1+ years expUSAJOBS is seeking a Program Integrity Analyst (Health Insurance) for the Department of Health & Human Services. In this role, you will develop, evaluate, and implement program integrity initiatives to support CMS' lines of business, ensuring compliance and safeguarding agency programs.
ConsultingGovernmentHuman ResourcesInformation TechnologyInternetStaffing Agency
No H1B
U.S. Citizen Only
Responsibilities
Review and evaluate financial program payments, identify areas of potential non-compliance, investigate fraud, waste, and abuse allegations, and conduct thorough program integrity reviews to safeguard Agency programs
Review and comment on new or proposed policy revisions, regulations, administrative sanctions, and legislation to determine their impact on contractor/provider operations and program safeguarding effectiveness
Study healthcare financing or delivery systems data and conduct complex analytical projects involving coordination across organizational lines
Establish and maintain effective working relationships with diverse contacts including State officials, government agency representatives, and healthcare industry officials
Apply extensive knowledge of Titles XVIII and XIX of the Social Security Act, healthcare laws (including Title XVII of the Public Health Service Act), and regulations to make recommendations for improving program operations
Qualification
Required
You must be a U.S. Citizen or National to apply for this position
You will be subject to a background and suitability investigation
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
In order to qualify for the GS-13, 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) Evaluating health insurance program vulnerabilities to detect fraud, waste, or abuse; 2) Collaborating across organizational lines on investigations, audits, or oversight of health insurance programs; AND 3) Proposing policy changes relating to program integrity
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
Benefits
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.
Company
USAJOBS
USAJOBS enables federal job seekers to access job opportunities across hundreds of federal agencies and organizations.
10001+ employees
Funding
Current Stage
Late StageRecent News
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