This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM), Division of Encounter Data & Risk Adjustment Operations (DEDRAO). As a Health Insurance Specialist (Program Oversight), GS-0107-11, you will develop, evaluate and implement compliance, audit and oversight requirements, policies, operating procedures related to health care insurance.

Duties

Develop, implement, and maintain program oversight strategy and processes, as well as maintain operational requirements, i.e., standard operating procedures and processes for entities that provide health care and prescription drug services. Gather and analyze information, conduct various reviews and studies to assess ongoing operations, program vulnerabilities, and initiate/recommend improvements or appropriate action. Interpret established polices and provide technical assistance regarding Agency programs to internal and external stakeholders. Respond to inquiries regarding program oversight activities and prepare a variety of written products, including position papers, manuals, reports, correspondence, briefing materials, etc.

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 WITHIN 30 DAYS OF 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. In order to qualify for the GS-11, 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-09 grade level in the Federal government, obtained in either the private or public sector), to include: Assisting in the development of processes used for the oversight of a health insurance programs (i.e., Medicare/Medicaid/CHIP/Affordable Care Act (ACA) or other private health insurances); Monitoring entities for compliance with health insurance program regulations and policies; AND Preparing briefing materials, manuals, or reports for health insurance program improvements. 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/12498170

Education

Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher level graduate education leading to such a degree or equivalent doctoral degree or LL.M., if related to the position being filled.
- OR -
Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at the grade GS-11. Therefore, only education in excess of a master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree, may be used to combine education and experience.

TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see "Required Documents" section below for what documentation is required at the time of application.

Contacts

• Address Center for Medicare 7500 Security Blvd Woodlawn, MD 21244 US
• Name: CMS HR Inquiries
• Email: [email protected]