Provider Enrollment Site Visit Analyst

Centers-For-Medicare-and-Medicaid-Services; Boston (MA); On-site; USD 65,000 - 90,000; Full time

Job summary

Centers for Medicare and Medicaid Services (CMS) in the Department of Health & Human Services seeks a Provider Enrollment Site Visit Analyst (GS-0107-9/11) to perform on-site compliance reviews of Medicare providers and suppliers. The role safeguards program integrity, beneficiaries, and taxpayer resources by validating adherence to regulations.

Responsibilities include reviewing laws and policies, gathering information to respond to inquiries, and collaborating with internal teams, contractors,

Qualifications

• Specialized experience in reviewing Medicare, Medicaid or Marketplace program integrity.
• Ability to gather information to respond to inquiries regarding program integrity.
• Collaboration with internal/external teams on investigations, audits, or compliance efforts.

Responsibilities

• Review proposed, amended, or newly implemented Medicare/Medicaid/Marketplace laws, regulations, and policies to assess compliance and provide corrective recommendations.
• Respond to basic inquiries regarding Medicare, Medicaid or Marketplace program integrity; support investigations and audits.
• Collaborate with internal teams and external agencies to assist with investigations and compliance efforts and write reports.

Education

Master's degree or equivalent graduate degree

Ph.D. or equivalent doctoral degree

Job description

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.

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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.