About this role
Job Summary
About the Position
This position is located in Aurora CO. Advanced Leave Accrual may be authorized. Salary negotiation may be available for those candidates who are new to Federal service. Student Loan repayment may be authorized.
Qualifications
Who May Apply: Only applicants who meet one of the employment authority categories below are eligible to apply for this job. You will be asked to identify which category or categories you meet, and to provide documents which prove you meet the category or categories you selected. Current Civilian Employees of the Defense Health Agency (DHA) Current Permanent Department of Defense (DoD) Civilian Employee Executive Order (E.O.) 12721 Interagency Career Transition Assistance Plan Land Management Workforce Flexibility Act Military Spouses, under Executive Order (E.O.) 13473 Non-Appropriated Fund Instrumentality (NAFI) Non-Department of Defense (DoD) Transfer Office of Personnel Management (OPM) Interchange Agreement Eligible People with Disabilities, Schedule A Priority Placement Program, DoD Military Reserve (MR) and National Guard (NG) Technician Eligible Priority Placement Program, DoD Military Spouse Preference (MSP) Eligible Priority Placement Program, DoD MR and NG Preference Eligible Tech Receiving Disability Retirement Priority Placement Program, DoD Retained Grade Preference Eligible Reinstatement Veterans Employment Opportunity Act (VEOA) of 1998 In order to qualify, you must meet the experience requirements described below.
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). You will receive credit for all qualifying experience, including volunteer experience. Your resume must clearly describe your relevant experience; if qualifying based on education, your transcripts will be required as part of your application. Additional information about transcripts is in this document.
GS-13 Specialized Experience: One year of specialized experience which includes assisting in the design, implementation, or evaluation of private-sector health care delivery projects through quantitative or qualitative analyses; supporting the development and assessment of medical benefits and provider reimbursement, including alternative payment models; and producing data-driven documents that inform senior leaders on medical benefits and reimbursement. This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-12).
Time in Grade Requirement: Applicants who have held a General Schedule (GS) position within the last 52 weeks must have 52 weeks of Federal service at the next lower grade or equivalent (GS-12). GS-14 Specialized Experience: One year of specialized experience which includes designing and implementing innovative private-sector health care programs using advanced quantitative or qualitative data analysis; providing expert guidance on medical benefits and provider reimbursement, including alternative payment models; and producing executive-level, data-driven documents that justify policy decisions and recommend actions related to private sector medical benefits or reimbursement to senior leaders.
This definition of specialized experience is typical of work performed at the next lower grade/level position in the federal service (GS-13). Time in Grade Requirement: Applicants who have held a General Schedule (GS) position within the last 52 weeks must have 52 weeks of Federal service at the next lower grade or equivalent (GS-13). Some federal jobs allow you to substitute your education for the required experience in order to qualify. For this job, you must meet the qualification requirement using experience alone--no substitution of education for experience is permitted.
You will be evaluated on the basis of your level of competency in the following areas: Accountability Attention to Detail Customer Service Decision Making Flexibility Influencing/Negotiating Integrity/Honesty Interpersonal Skills Learning Reading Comprehension Reasoning Self-Management Stress Tolerance Teamwork
Major Duties
- Manage provider reimbursement policy and medical benefit programs for over 9 million TRICARE beneficiaries worldwide, with particular emphasis on value-based care initiatives, alternative payment models, and specialized demonstration projects.
- Independently research, draft, and finalize authoritative, executive-level policy deliverables, including regulatory actions, legislative proposals, Department-level policy memoranda, Congressional responses, and contract modifications.
- Utilizing large claims datasets, prospective payment systems, and industry-standard coding taxonomies (e.g., ICD-10, CPT, HCPCS, DRGs) to assess private sector program effectiveness and identify systemic healthcare cost and quality drivers.
- Provide expert consultation and authoritative guidance to health care contractors on program medical benefit policy and reimbursement principles, policies, regulations and instructions.
- Collaborate with interagency and private-sector partners (including CMS, VA, and commercial health insurers) on novel approaches to private sector health care delivery.
- Serve as a key technical advisor to leadership and external authorities (such as the Department of Justice and GAO) on complex healthcare medical benefit policy and provider reimbursement.