Medicare/Medicaid Program Integrity Advisor

USmax is seeking a Medicare/Medicaid Program Integrity Advisor for the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), and the Center for Program Integrity (CPI). 

This role will support events, e-learning curriculum, and course development. This includes developing and updating educational and outreach materials (courses, tools, fact sheets, etc.) for fraud, waste, and abuse (FWA), and analyzing and identifying education and outreach opportunities to address vulnerabilities and known fraud schemes within CMS programs. The Medicare/Medicaid Program Integrity (PI) Advisor will ensure quality and compliance with current CMS guidance and regulations.

Duties and 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

Required Qualifications: 

• 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

Required Experience:

• (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

Required Education: 

• Bachelor’s degree

Preferred Experience: 

• Seven to ten years supporting CMS CPI initiatives
• Five years reviewing policy and regulatory guidance

Security Clearance Requirements:

• N/A

Work Location / Schedule:

• Remote position

USmax Corporation is an award-winning SBA Certified Woman-Owned Small Business and leading provider of innovative professional, technical and enterprise IT services. Our client areas span, national security, public safety and healthcare markets.  

Our Commitment to quality and continuous process improvement is demonstrated by our ISO 9001:2015, ISO 20000-1:2018, and ISO 27001:2013 registrations. We offer complete program life cycle support through a full range of planning, design, implementation, management, and support services. Our services based on trust, quality, efficiency, and innovation drive the mission of our various federal and commercial customers. 

USmax  is certified by the Commonwealth of Virginia Department of Veterans Services as a Virginia Values Veterans (V3) Facility and certified as a V3 Certified Employer. USmax is an avid supporter of the men and women who have served our country. This certification recognizes this achievement and furthers our commitment to veterans and their families.  

USmax is an Equal Opportunity Employer.  Please see our website to learn more about our employment policies or to request accommodation to enable you to apply for employment.

For more information about USmax or to apply for a position, visit www.usmax.com.