Provider Enrollment Site Visit Analyst

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, Provider Enrollment & Oversight Group (PEOG). As a Provider Enrollment Site Visit Analyst, GS-0107-9/11, the incumbent carries out compliance reviews of Medicare providers and suppliers by visiting their physical locations/worksites. This helps ensure program integrity and safeguards Medicare beneficiaries and taxpayer resources.

Duties

Reviews financial payments and provider enrollment to identify fraud, waste, and abuse. Applies established methods to analyze allegations, uses protocols to assess operational issues, and conducts studies to address program vulnerabilities.
Develops and interprets policies and regulations for program integrity. Identifies policy issues, recommends solutions, formulates conclusions that inform management decisions, and conducts studies to improve sanctions and integrity initiatives.
Collaborates with CMS, state agencies, contractors, and providers, as well as external agencies like HHS OIG, FBI, and DOJ on FWA matters. Compiles case summaries and engages with officials across the health care sector.
Communicates findings through briefings and reports, represents the agency at meetings, provides technical advice on program vulnerabilities, and responds to inquiries about provider enrollment and integrity issues

Requirements

Qualifications
ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume (limited to no more than 2 pages) must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration. In order to qualify for the GS-09, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-07 grade level in the Federal government, obtained in either the private or public sector, to include: 1. Assisting with reviews of proposed, amended, or newly implemented Medicare, Medicaid and/or Marketplace laws, regulations, and policies to assess program compliance and provide recommendations for corrective measures; 2. Supporting team by gathering information to respond to basic written, telephonic, or electronic inquiries regarding Medicare, Medicaid or Marketplace program integrity; And 3. Collaborating with internal teams, external agencies, contractors, or oversight bodies to help with investigations, audits, or compliance efforts involving health insurance programs. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 level by possessing a Master's or equivalent graduate degree or 2 full years of progressively higher-level graduate education leading to such a degree or LL.B. or J.D., if related to the position being filled. - OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-07 grade level may be used to qualify applicants for positions at grades GS-09. Therefore, only education in excess of 1 full year of graduate-level education may be used to combine education and experience. TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the "Required Documents" section below for the documentation required at the time of application. In order to qualify for the GS-11, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-09 grade level in the Federal government, obtained in either the private or public sector, to include: 1.Reviewing proposed, amended, or newly implemented Medicare, Medicaid and/or Marketplace laws, regulations, and policies to assess program compliance and provide recommendations for corrective measures; 2. Responding to basic written, telephonic, or electronic inquiries regarding Medicare, Medicaid or Marketplace program integrity; And 3. Collaborating with internal teams, external agencies, contractors, or oversight bodies to help with investigations, audits, or compliance efforts involving health insurance programs; this includes writing reports. - OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher-level graduate education leading to such a degree or equivalent doctoral degree or LL.M., if related to the position being filled. - OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at grades GS-11. Therefore, only education in excess of a master's or equivalent graduate degree or 2 full years of progressively higher-level graduate education leading to such a degree may be used to combine education and experience. TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to the substitution of education for experience and the combination of experience and education. Please refer to the "Required Documents" section below for the documentation required at the time of application. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional, philanthropic, religious, spiritual, community, student, social). Volunteer work helps build critical competencies, knowledge, and skills, and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.

Education
TRANSCRIPTS are required to verify satisfactory completion of the educational requirement listed above. Failure to submit a copy of your transcripts at the time of application WILL result in an ineligible rating. Please see "Required Documents" section below for what documentation is required at the time of application. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/13042592

Required Documents

The following documents are REQUIRED: 1. Resume showing relevant experience; cover letter optional. NOTE: As of September 27, 2025, federal agencies will only accept resumes that are two pages or less in length. Your resume must indicate your citizenship and whether you are registered with the Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable), including the start and end dates (mm/yyyy) of each employment, along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips, visit: https://www.cms.gov/files/document/2026-required-documents.pdf 2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration. 3. College Transcripts. Since this position requires specific education, you must submit a transcript attesting to your possession of the required education. You may submit an unofficial transcript or a list of college courses completed, indicating course titles, credit hours, and grades received. An official transcript is required if you are selected for the position. If selected, you must provide an original document before the final job offer may be extended. If you do not submit a transcript indicating your possession of the required education, you will not be considered for this position. College Transcripts and Foreign Education: Applicants who have completed part or all of their education outside the U.S. must have their foreign education evaluated by an accredited organization to ensure that it is comparable to the education received in accredited educational institutions in the U.S. For a listing of services that can perform this evaluation, visit the National Association of Credential Evaluation Services website. This list, which may not be all-inclusive, is for informational purposes only and does not imply any endorsement of any specific agency. If you are applying for a position for which a state license is issued (e.g., physician, engineer, attorney), possession of a valid and current U.S. professional license by a graduate of a foreign professional school or program is sufficient proof that the foreign education has been determined to be equivalent to the requisite U.S. professional education in that occupational field. PLEASE NOTE: A complete application package includes the online application, resume, transcripts, and CMS required documents. Please carefully review the full job announcement, which includes the "Required Documents" and "How to Apply" sections. Failure to submit the online application, resume, transcripts, and CMS required documents will result in your not being considered for employment.