Medicare/Medicaid FWA SME (Remote)

USmax Corporation; Oregon; Hybrid; USD 90,000 - 130,000; Full time

Job summary

USmax Corporation is seeking a Subject Matter Expert (SME) in Medicare/Medicaid Fraud, Waste, and Abuse to join our growing team. You will support CMS CPI initiatives, develop training materials, and translate complex CMS guidance into clear educational content for program stakeholders.

The role emphasizes collaboration with CMS programs and federal partners, with a focus on staying current with evolving regulations and applying best practices in training and outreach across Medicare, Medicaid,

Qualifications

• Bachelor's degree from an accredited college or university.
• 3+ years supporting Medicare, Medicaid, healthcare program integrity, FWA, or related healthcare compliance initiatives.
• Experience developing or reviewing educational, outreach, training, or technical materials supporting healthcare program integrity initiatives.
• Experience collaborating with CMS programs and federal, state, or contractor partners supporting CMS initiatives.
• Knowledge of CMS Program Integrity regulations, Medicare and Medicaid policies, and applicable federal guidance.
• Proficiency with Microsoft Office applications and collaboration tools, including SharePoint.

Responsibilities

• Provide subject matter expertise on Medicare, Medicaid, Marketplace, and CMS Program Integrity initiatives related to fraud, waste, and abuse (FWA).
• Analyze emerging fraud schemes, regulatory changes, and program integrity trends to identify vulnerabilities and recommend education and outreach strategies.
• Develop, review, and update educational, outreach, and training materials to ensure alignment with current CMS guidance, policies, and regulations.
• Collaborate with project leadership, program stakeholders, and cross-functional teams to provide technical guidance and support program objectives.
• Review deliverables for technical accuracy, quality, consistency, and compliance with applicable CMS requirements.
• Interpret CMS policies, guidance, and regulatory changes and translate complex information into clear, actionable educational content.
• Support program staff by providing subject matter expertise on CMS Program Integrity policies, initiatives, and best practices.
• Perform other duties as assigned.

Skills

Healthcare program integrity

CMS policies

Educational materials development

Collaboration with CMS partners

Education

Bachelor's degree

Tools

Microsoft Office

SharePoint

Job description

USmax Corporation is seeking a Subject Matter Expert (SME) in Medicare/Medicaid Fraud, Waste, and Abuse to join our growing team. You will support CMS CPI initiatives, develop training materials, and translate complex CMS guidance into clear educational content for program stakeholders.

The role emphasizes collaboration with CMS programs and federal partners, with a focus on staying current with evolving regulations and applying best practices in training and outreach across Medicare, Medicaid,