Medicare/Medicaid Program Integrity Advisor
U
USmaxHealthcare Compliance
United StatesFull-TimeMiddle
Salary110,000 - 140,000 USD per year
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Job Details
- Experience
- (5) years minimum experience
- Required Skills
- SharePointMicrosoft Office
Requirements
- Bachelor’s degree
- 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
- Proficient in Microsoft Office Applications (Outlook, Word, Excel, PowerPoint, and SharePoint)
- 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
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
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