Health Insurance Specialist @ Centers for Medicare & Medicaid Services

Job Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Financial Management,. Payment Accuracy and Reporting Group, Division of Medicare Advantage and Drug Error Rate As a Health Insurance Specialist, GS-0107-12, you will develop, evaluate and implement compliance, audit and oversight requirements, policies and operating procedures.

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 receiving further consideration. In order to qualify for the GS-12, 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-11 grade level in the Federal government, obtained in either the private or public sector, to include: Analyzing and interpreting federal health insurance laws, regulations, and policies (such as those governing Medicare Part C and D) to evaluate program operations, identify improper payment vulnerabilities, or recommend improvements to payment accuracy measurement programs.

Applying program payment policy to identify improvements or refine existing methodology to evaluate program operations for an improper payment measurement program. Utilize project management tools and techniques to plan, conduct, or evaluate improper payment measurement programs and deliverables to ensure timely measurement and reporting. Substitution of Education for Experience: There is no substitution of education to meet the specialized experience requirement at the GS-12 grade level. Combination of Experience and Education: There is no combination of experience and education to meet the specialized experience requirement at the GS-12 grade level.

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 or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year 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/13090088

Major Duties

• Researching Part C and D program issues and developing responses. Assisting in preparing briefing materials and reports. Overseeing the operation of contractors to ensure the timely production of annual Medicare Part C and D improper payment rates. Providing subject matter expertise in reviewing contractor issues, evaluating budget issues, and addressing other contractual issues, such as reviewing contractor statements of work, proposals, and independent government cost estimates. Responding to inquiries regarding program oversight activities from a variety of internal and external stakeholders (e.g., beneficiaries, providers, representatives of public and private organizations, congressional staff, and other government organizations).