This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Financial Management (OFM), Division of Medicare Secondary Payer Program Operations. As a Health Insurance Specialist, GS-0107-13, you will develop, evaluate, and execute policies and operational procedures related to activities and processes in support of Medicare's Coordination of Benefits and Recovery program (COB&R).

Duties

Serve as an expert in the development, evaluation, of policies related to activities and processes involved with the monitoring and oversight of external CMS stakeholders who contract or provide services in support of CMS’ COBR program. Develop, implement, and maintain operational requirements, including program oversight. Develop and review health care policies and legislation in order to draft related documents, procedures, and guidance. Respond to inquiries regarding program oversight activities to a variety of internal and external stakeholders. Coordinate and prepare responses to oversight entities including the Office of the Inspector General (OIG) and Government Accountability Office (GAO) and monitor progress of associated corrective action plans.

Requirements

• 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 BY THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume 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. To qualify for the GS-13, 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-12 grade level in the Federal government, obtained in either the private or public sector, to include): Experience with processes utilized by CMS to identify and recover conditional payments, and which are related to Medicare Secondary Payer (MSP) Non-Group Health Plan debts, including the processes for the full resolution of those debts; Experience in reviewing and identifying Medicare claims and determining whether claims are related to a Medicare Secondary Payer (MSP) Non-Group Health Plan (NGHP) occurrence and appropriate for Medicare to recover from a secondary payer such as an insurer, defendant or beneficiary's settlement; AND Experience with the CMS systems used to support the Coordination of Benefits and Recovery (COB&R) program for recoveries, including but not limited to the Benefits Coordination and Recovery System (BCRS) and the Common Working File (CWF). 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. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12192593

Education

This job does not have an education qualification requirement.

Contacts

• Address Office of Financial Management 7500 Security Blvd Woodlawn, MD 21244 US
• Name: CMS HR Inquiries
• Email: [email protected]