Medicare & Medicaid Program Integrity SME

Unissant, Inc. delivers innovative capabilities to the agencies that keep our nation healthy and safe. We apply our domain expertise, data acumen, and technology know-how to achieve breakthrough results for our clients. Working collaboratively, we advance missions and careers through a focus on honesty, integrity, and dependability. We continuously look for talent, excited to join that effort. To learn more about our exciting organization, please visit us at . We are seeking a highly knowledgeable and experienced Program Analyst/Subject Matter Expert (SME) to join our team in the Baltimore-Washington Metro Area to support the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity (CPI). The SME will play a critical role in helping CMS prevent, detect, and reduce fraud, waste, and abuse in Medicare and Medicaid programs. The ideal candidate will have in-depth expertise in healthcare program integrity, CMS policies and systems, and data-driven fraud detection and mitigation strategies. Essential Duties and Responsibilities:

• Provide expert guidance on program integrity strategies, operations, and policy recommendations related to CMS' efforts to combat fraud, waste, and abuse.
• Serve as a key advisor on the development and implementation of proposals, audits, investigations, data analytics initiatives, and compliance monitoring programs.
• Support various stakeholders by translating technical findings into actionable program and policy insights.
• Assist in the evaluation of program integrity models and initiatives to ensure effectiveness and regulatory compliance.
• Conduct research and provide subject matter input on legislative, regulatory, and operational impacts to CMS program integrity.
• Collaborate with internal and external stakeholders, including other CMS components, federal partners and private sector entities.
• Review and provide feedback on program documentation, reports, performance measures, and analytic tools.
• Participate in strategic planning, training, and outreach efforts as needed.

Work Experience:

• Minimum 7 years of experience in healthcare fraud, waste, and abuse prevention, with at least 3 years focused on CMS or Medicare/Medicaid program integrity.
• Deep understanding of CMS structure, mission, and regulatory environment.
• Demonstrated experience in healthcare program audits, investigations, or data analytics.
• Strong knowledge of relevant statutes, such as the False Claims Act, Anti-Kickback Statute, and program exclusion laws.
• Experience creating detailed reports and giving presentations

Job Skills:

• Proficient in personal computer skills with MS Office (Word, Excel, Power Point, Outlook, MS Project, MS Visio)
• Excellent planning, organizational, and time management skills
• Ability to prioritize and multi-task in a fast paced, changing environment
• Ability to influence stakeholders and work closely with them to determine acceptable solutions
• Excellent documentation skills
• Fundamental analytical and conceptual thinking skills
• Ability to set goals and deadlines
• Ability to maintain professionalism when interacting with internal and external customers

Preferred Qualifications:

• Experience supporting CMS contracts and systems
• Familiarity with the claims process
• Active clearance or the ability to obtain a Public Trust clearance

Education:

• Bachelor's Degree in Public Health, Health Policy, Healthcare Administration, Law, or a related field. Master's Degree preferred.

Communication Skills:

• Solid ability to interface, inspire and motivate at various levels of the organization.
• Ability to convey technical information to non-technical individuals.
• Demonstrated experience communicating effectively across internal and external organizations.

Travel:

• Local

Environmental Requirements:

• Mainly sedentary; in an office environment.
• May be required to lift up to ten (10) pounds
• Flexible in working extended hours

The above statements are intended to describe the general nature and level of work being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. Unissant management reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, where applicable and available, reasonable accommodation(s) may be made to enable individuals with disabilities to perform essential functions of this position. Please note: Candidate(s) will be required to go through pre-employment screening. Unissant, Inc. is a proud Equal Opportunity Employer! (EOE; M/F/D/V) Apply Job! Apply to this Job