[Remote] Medicare/Medicaid Program Integrity Advisor
Note: The job is a remote job and is open to candidates in USA. USmax Corporation is an award-winning SBA Certified Woman-Owned Small Business providing innovative professional, technical, and enterprise IT services. They are seeking a Medicare/Medicaid Program Integrity Advisor to support the U.S. Department of Health and Human Services by developing educational and outreach materials for fraud, waste, and abuse, while ensuring compliance with CMS guidance and regulations.
Responsibilities
- Perform a thorough review of peer submissions to ensure submission quality and compliance with current CMS guidance and regulations
- Serve as the Program Integrity subject matter expert and provide guidance on CMS PI-related questions and initiatives
- Stay current with emerging CMS PI guidance, industry expectations, and standards, and demonstrate the ability to translate these into educational materials for CPI stakeholders
- Research and interpret CMS regulations, guidance, manuals, and policy updates
- Provide expert consultation regarding Program Integrity initiatives
- Review educational content for technical accuracy
- Identify emerging fraud schemes and vulnerabilities
- Recommend outreach and training strategies
- Participate in stakeholder meetings and workgroups
- Support development of fact sheets, toolkits, webinars, and training products
- Other duties as assigned
Skills
- Proficient in Microsoft Office Applications (Microsoft Outlook, Word, Excel, PowerPoint, and SharePoint); advanced knowledge of Excel formulas preferred
- Excellent verbal and written communication and presentation skills
- Ability to proactively anticipate project needs, support project strategy and implementation
- Organized, detail-oriented, self-motivated, efficient, flexible, and able to meet deadlines
- Experience executing in a high-paced, evolving environment with short deadlines
- Ability to comprehend and provide analysis of deliverables and related customer-facing materials
- Ability to demonstrate sound judgment, attention to detail, and critical thinking
- Ability to work independently
- (5) years minimum experience supporting Medicare, Medicaid, or healthcare Program Integrity initiatives
- Thorough understanding of CMS Program Integrity regulations, Medicare and Medicaid guidance, policy directives, and related federal requirements
- Demonstrated expertise in CMS Program Integrity operations and policy
- Bachelor's degree
- Seven to ten years supporting CMS CPI initiatives
- Five years reviewing policy and regulatory guidance
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