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Director, Division of Provider Enrollment Appeals

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Program Integrity (CPI)

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity, (CPI), Provider Enrollment & Oversight Group (PEOG).

As a Supervisory Health Insurance Specialist, referred to here as the Director, Division of Provider Enrollment Appeals, GS-0107-15, you will provide day-to-day technical expertise, advice, and consultation on a range of issues aimed at identifying and addressing vulnerabilities.

Overview

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Accepting applications
Open & closing dates
02/18/2026 to 02/24/2026
Salary
$169,279 to - $197,200 per year
Pay scale & grade
GS 15
Location
1 vacancy in the following location:
Woodlawn, MD
Remote job
No
Telework eligible
Yes—as determined by the agency policy.
Travel Required
Occasional travel - You may be expected to travel up to 5% for this position.
Relocation expenses reimbursed
No
Appointment type
Permanent
Work schedule
Full-time
Service
Competitive
Promotion potential
15
Supervisory status
Yes
Security clearance
Not Required
Drug test
No
Position sensitivity and risk
Moderate Risk (MR)
Trust determination process
Financial disclosure
Yes
Bargaining unit status
No
Announcement number
CMS-CPI-26-12885231-IMP
Control number
857891700

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Duties

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  • Supervise staff responsible for managing provider/supplier enrollment corrective action plans (CAPs) and reconsiderations for Medicare providers and suppliers whose billing privileges are denied or revoked.
  • Serve as hearing officer conducting paper reviews of reconsideration requests and rendering final agency-level determinations on provider denials, revocations of billing privileges, and effective dates.
  • Provide technical guidance to CMS leadership and stakeholders on provider/supplier enrollment compliance, appeals, and program integrity issues that intersect Medicare and Medicaid enrollment to prevent, detect, and deter fraud, waste, and abuse.
  • Oversee cross-jurisdictional projects and studies aligned with HHS and CMS strategic goals to combat program fraud, waste, and abuse, including contract management, budget oversight, and coordination with Medicare Administrative Contractors.
  • Develop and implement enrollment policies and procedures across Medicare and Medicaid programs.

Requirements

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Conditions of employment

  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.
  • Time-in-Grade restrictions apply.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF 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 being considered further.


In order to qualify for the GS-15 , 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-14 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Implementing program integrity or provider enrollment related policies, procedures, or strategic plans; AND 2) Advising leadership and stakeholders on Medicare or Medicaid policy; AND 3) Supervising or leading work performed by subordinate staff or planning, organizing, or assessing the work activities of teams (e.g. setting and adjusting short-term priorities, preparing/adjusting schedules for completion of work).

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.

Time-in-Grade: To be eligible, current Federal employees must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12885231

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: No
Tour of Duty: Flexible
Recruitment Incentive: Not Authorized
Relocation Incentive: Not Authorized
Financial Disclosure: Required

Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement. CMS offers flexible working arrangements and allows employees the opportunity to participate in alternative work schedules at the manager's discretion.

The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.

Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution.

How you will be evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), the responses you provide on the application questionnaire, and the results of the online assessments required for this position. Please follow all instructions carefully. Errors or omissions may affect your rating.

You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics):


In order to be considered for this position, you must complete all required steps in the process. In addition to the application and application questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job.

The assessment includes a cut score based on the minimum level of required proficiency in these critical general competencies. You must meet or exceed the cut score to be considered. You will not be considered for the position if you score below the cut score or fail to complete the assessment.

Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on the online assessment may also result in your removal from consideration.

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