Department of Health and Human Services
This position is within the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, Provider Compliance Group (PCG). As a Nurse, GS-0610-11/12, you will provide authoritative clinical and nursing advice and guidance as part of CMS program policy or support teams responsible for interpreting applicable laws, regulations, and policies for complex, controversial or sensitive issues in CMS-administered program.
- Conducts in-depth research on the background and origin of laws, regulations, and policies, and their intended impact on healthcare programs.
- Works with various CMS components on data interpretation, recovery audits, claims processing and payment, medical review, and appeals to ensure consistent and accurate implementation of clinical Medicare policy.
- Supports cross-functional and cross-organizational teams on projects and initiatives that impact program integrity operations.
- Participates in and leads analytical studies to evaluate the effectiveness of policies by gathering, organizing, and interpreting clinical and program data.
- Serves as a CMS point of contact for beneficiaries, providers, suppliers, professional associations, congressional offices, and contractors.
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Listed under Healthcare & Nursing jobs.