What are the responsibilities and job description for the Federal Healthcare Program SME position at etelligentgroup?
Company Overview:
Over the past 15 years, eTel has delivered essential solutions for the federal government by securing and managing data, providing scalable identity access, modernizing legacy systems, and building high-performance platforms. By integrating new technologies and ensuring reliable operations we help agencies stay prepared for future challenges As a premier technology solutions and services company to the US federal government, eTel possesses longstanding relationships across the federal civilian marketplace. Other customers include the broader Treasury Department, Commerce Department, and State Department.
eTel offers integrated CMMI Level 3 processes, tools, and techniques with innovative, cost-efficient, and secure solutions to address complex challenges. eTel also holds ISO 9001:2015, ISO/IEC 27001:2013, and ISO/IEC 20000-1:2018 certifications, and offers dedicated subject matter experts (SMEs) and thought leaders that possess a deep understanding of customers’ environments and challenges.
Security Clearance: Secret or TS clearance (Mandatory). Candidates without active secret clearance will not be considered.
Citizenship: US Citizen (MUST)
Overview:
The Federal Healthcare Program Subject Matter Expert (SME) provides domain leadership on Medicare/Medicaid provider systems, program integrity initiatives, and investigative data management. This role guides design decisions ensuring alignment with CPI’s mission.
Core Responsibilities:
- Advise on Medicare and Medicaid program integrity workflows.
- Provide expertise in provider enrollment, credentialing, and oversight (PECOS, NPPES).
- Support integration of investigative data from OnePI, UCM, and related CPI systems.
- Translate business rules and regulatory requirements into technical designs.
- Assist in defining measurable objectives and success metrics for API services.
- Participate in governance, change control, and quality reviews.
Required Experience:
- 10 years in Medicare/Medicaid systems or CMS program integrity operations.
- Deep knowledge of FWA (Fraud, Waste, and Abuse) detection and investigative processes.
- Familiarity with CPI systems such as PECOS, NPPES, UCM, and OnePI.
- Experience advising Agile development teams on federal healthcare data.
Certifications:
- Certified in Healthcare Compliance (CHC) or equivalent.
- PMP or Agile certification (optional).
Location: Work will be primarily onsite in Washington, DC, or other designated sites. Remote work requires prior client approval. Local and occasional out-of-area travel may be required.
Commitment to Diversity -
eTelligent Group provides equal employment opportunities (EEO) to all applicants without regard to race, color, religion, gender, sexual orientation, gender identity, nations origin, age, disability, genetic information, marital status, amnesty, status as a covered veteran, and any other characteristic provided in accordance with applicable, federal, state and local laws.
