Health Insurance Specialist

Duties

Provide expert policy analysis and technical guidance on the Payment Integrity Information Act (PIIA) and Medicare Fee-for-Service (FFS) improper payment measurement program, ensuring consistent interpretation of legislation, regulations, coverage policies, and billing requirements.

Guide CMS contractors and Medicare Administrative Contractors (MACs) in implementing program policies, reviewing improper payment reports and reduction strategies, and educating stakeholders on compliance and reporting requirements.

Develop, implement, and evaluate program initiatives to improve operational efficiency, identify root causes of improper payments, mitigate risks, and recommend policy and procedural improvements.

Conduct special studies, comparative analyses, and program evaluations to assess payment integrity, identify emerging trends, validate analytical models, and determine the feasibility of large-scale reviews and audits.

Prepare regulations, sub-regulatory guidance, briefing materials, congressional reports, and financial reporting content; advise CMS leadership, represent the agency before stakeholders, and coordinate responses to complex program inquiries.