This position is located in the Center for Medicare, Centers for Medicare and Medicaid Services (CMS). As the Director, you will provide executive leadership, direction and coordination for the Provider Billing Group (PBG). The position provides executive direction to activities necessary to ensure the successful completion of planning, and implementation of program management for the operational policies and budget guidelines for claims processing in the Medicare fee-for-service (FFS) program.

Duties

Leads and directs the development of the requirements, methods, standards, policies, procedures, and budget guidelines for Medicare FFS claims processing related activities. Provides operational expertise to the development and implementation of Agency policies, regulations, procedures, new payment models and legislative proposals, taking into consideration the impacts on affected stakeholders and business processes. Coordinates modifications to existing operational procedures, contracts, and related materials, as required. Recommends alternatives to existing processes, policies, and procedures, as well as methods of improvement. Identifies and reacts to deficiencies in Medicare FFS claims processing requirements and develops instructions and guidelines for proper claims processing, including findings identified in OIG and GAO reports. Directs the development and release of pricing software and files used in Medicare FFS claims processing for institutional, professional and supplier claims, including Pricers, fee schedules, and coding files. Directs the development of data analysis programs and software modules necessary to support Medicare FFS payment policy development.

Requirements

• U.S. Citizenship required.
• Background and/or Security Investigation required.
• One year SES probationary period required.
• The Ethics in Government Act, PL 95-521 requires the applicant selected for this position to submit a financial disclosure statement, SF-278, prior to assuming the SES position, annually, and upon termination of employment.
• Status applicants must submit a copy of their most recent SF-50, Notification of Personnel Action, which verifies status.
• All initial appointments to an SES position are contingent on approval from OPM's Qualifications Review Board unless the selectee has successfully participated in an OPM approved SES Candidate Development Program.
• All male applicants born after December 31, 1959, must have registered for the selective service. You will be required to sign a statement certifying his registration, or the applicant must demonstrate exempt status under the Selective Service Law.
• Only experience obtained by the closing date of this announcement will be considered.

Qualifications

All competitive candidates for SES positions with the Federal Government must demonstrate leadership experience indicative of senior executive level management capability. To meet the minimum qualification requirements for this position, you must show in your resume that you possess the Fundamental Competencies, five Executive Core Qualifications, and the Professional/Technical Qualifications listed below. Evidence of this experience must be incorporated into your five page resume. Separate narratives for the Executive Core Qualifications and/or Professional/Technical Qualifications will not be accepted or considered. Typically, experience of this nature is gained at or above the GS-15 grade level in the Federal service, or its equivalent with state or local government, the private sector, or nongovernmental organizations. Fundamental Competencies: Interpersonal Skills, Oral Communication, Integrity/Honesty, Written Communication, Continual Learning, and Public Service Motivation. Executive Core Qualifications (ECQs) Leading Change: The ability to bring about strategic change, both within and outside the organization, to meet organizational goals. Inherent to this ECQ is the ability to establish an organizational vision and to implement it in a continuously changing environment. Leading People: The ability to lead people toward meeting the organization's vision, mission, and goals. Inherent to this ECQ is the ability to provide an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts. Results Driven: The ability to meet organizational goals and customer expectations. Inherent to this ECQ is the ability to make decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks. Business Acumen: The ability to manage human, financial, and information resources strategically. Building Coalitions: The ability to build coalitions internally and with other Federal agencies, State and local governments, nonprofit and private sector organizations, foreign governments, or international organizations to achieve common goals. Professional/Technical Qualifications (PTQs) This position also requires that you possess PTQs that represent knowledge, skills, and abilities essential for success in this role. The following PTQs must be evident in your resume. Demonstrated knowledge and leadership experience related to a large-scale health care program or entity, including the critical operational, policy, and financial forces that influence organizational results. Demonstrated experience, in an executive leadership position, in negotiation and collaboration with a wide range of senior leaders on complex issues concerning a national/state health care program or large-scale health care entity. Demonstrated experience in developing and managing implementation of a strategic plan for a large-scale health care program or entity. It is STRONGLY recommended that you visit the following Office of Personnel Management (OPM) webpage for more information regarding the Fundamental Competencies and ECQs. https://www.opm.gov/policy-data-oversight/senior-executive-service/executive-core-qualifications/#url=Overview If selected, you will be required to complete an ECQ package by drafting narratives for each of the ECQs for submission and certification by an OPM Qualifications Review Board (QRB) in order to be placed in this position. If you are currently serving in a career SES appointment, are eligible for reinstatement into the SES, or have successfully completed an SES Candidate Development Program approved by the Office of Personnel Management (OPM), you will not need to draft the ECQs.

Education

This job does not have an education qualification requirement.

Contacts

• Address Center for Medicare 7500 Security Blvd Woodlawn, MD 21244 US
• Name: Margaret Moore
• Phone: 000-000-0000
• Email: [email protected]