SRA International, Inc., A CSRA Company Mid Level Investigator in Rockville, Maryland

Clearance Level Must Currently Possess:

Clearance Level Must Be Able to Obtain:

Suitability:

Job Family:

Engineering & Sciences

Job Description:

Job Description

The Affordable Care Act (ACA) requires every state to establish a health insurance exchange (also called Health Insurance MarketplaceSM) to facilitate the purchase of health insurance for individuals and small businesses. Through the Center of Program Integrity (CPI), CMS has strong oversight and internal controls to protect consumers enrolled in the Marketplaces and safeguard taxpayer dollars. CMS develops and enforces rules for insurance agents, and brokers and others who assist with FFM enrollments. The Marketplace Program Integrity Contractor (MPIC) is designed to support this oversight. Through research, investigation and data analysis, the desired outcomes of the MPIC efforts are to prevent, detect, and resolve noncompliance with Marketplace rules, requirements, and laws; recommend administrative action to CMS; and recommend referral to law enforcement if potential fraud and abuse is identified.

Responsibilities

  • Work collaboratively within a team of ACA policy expert SMEs and data analysts

  • Actively participate in the development of lead and investigation workflows and required data capture within a case management system.

  • Strictly follow CMS-approved SOPs as to how to conduct fraud, waste and abuse (FWA) lead reviews and investigations and have input into recommendations for SOP updates as needed.

  • Prioritize, evaluate and analyze information in the screening of claims (leads) of potential fraud, waste and abuse (FWA) within the ACA activity related to enrolling consumers into qualified health plans and/or agents/brokers non-compliance with regulations. Make administrative recommendations to CMS, e.g. further investigation, education, site visits

  • As needed, develop an Investigative Plan of Action (IPOA) and with CMS approval, implement the plan with the support of Junior and Senior Investigators into the potential FWA behavior through such techniques as reactive data analysis, audits, interviews, secret shopping, site visits.

  • Within a case management system, comprehensively document in detail all lead and investigation activity and recommendations to CMS.

  • As needed with CMS approval correspond with agents/brokers or other government agencies using CMS-approved template

  • Actively support preparation of comprehensive reports on the status of leads and investigations required by CMS.

  • Asist in adhoc educational and outreach sessions with partners, e.g. CMS, law enforcement, Agent/brokers, Navigators.

  • Safequard PII and PHI

  • Infrequent travel may be required

Qualifications

  • Bachelor’s degree or equivalency in healthcare field that includes 2-4 years’ ACA and/or Medicaid-Medicare experience

  • Experience with and in-depth understanding of ACA policies and regulations related to consumer enrollments requirements and Agent/Broker and Navigator responsibilities

  • Frequently led workgroups to successful completion of goals and milestones

  • Highly organized, ability to multi-task and meet deadlines

  • Proficient in computer skills, e.g. Microsoft Office-Word, Excel

  • Requires only limited oversight to conduct work

  • Strong inter-personal and communications skills, both written and oral

  • Ability to conceptualize, solve problems and draw conclusions

Value-Add Experience

  • Experience with FWA claims and investigations

# of Openings:

0

Scheduled Weekly Hours:

40

T elecommuting Options:

Work Location:

USA MD Rockville - 6003 Executive Blvd, Ste 400 (MDC053)

Additional Work Locations:

USA VA Home Office (VAHOME)

CSRA is committed to creating a diverse environment and is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

THINK NEXT. NOW.

CSRA is tomorrow’s thinking, today. To “Think Next. Now.” is to imagine a better future and to deliver it, today. For our customers, our partners, and ultimately, all the people our mission touches, CSRA is realizing the promise of technology to change the world through next-generation thinking and meaningful results.

We understand that our customers' missions require new methods and imaginative thinking. We bring together government IT professionals, emerging technologies, and the brightest, cutting-edge advisors in the industry to deliver a broad range of innovative, next-generation IT solutions and professional services to help our customers modernize their legacy systems, protect their networks and assets, and improve the effectiveness and efficiency of mission-critical functions for our warfighters and our citizens.

Everywhere you look, CSRA is there. We’re in our nation’s infrastructure, in training and education, in cyber security, in serving veterans who served us—and, so much more. Take some time to learn more about CSRA. You might be surprised to learn how we touch your life.

We are a company of 18,000+ smart, talented individuals, yet we enjoy a start-up culture that inspires us to make a difference while delivering results in this rapidly evolving world. Join our team and use your skills and expertise to support the safety, security, health and well-being of the nation.