Nurse (Program Vulnerability Detection & Prevention)

3 weeks ago


Woodlawn, Ohio, United States Department Of Health And Human Services Full time
Summary

This position is located in the Dept. of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Financial Management (OFM), Div. of Medicare Advantage and Drug Error Rate, Payment Accuracy and Report Group.

As a Nurse (Program Vulnerability Detection & Prevention), GS /12, you will provide clinical guidance as part of CMS program policy or support teams, responsible for interpreting applicable laws, regulations, and policies for CMS insurance programs.



Duties
  • Identify trends and problem areas and recommends needed revisions to existing program policies, criteria, standards, and procedures.
  • Coordinate with stakeholders to develop solutions to program problems.
  • Work with CMS components on data interpretation, recovery audits, claims processing and payment, medical review, and appeals to ensure accurate implementation of clinical healthcare policy.
  • Track effectiveness of corrective actions to identify, monitor, and mitigate program vulnerabilities and reduce improper payments.

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