This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM), Medicare Part C & D Oversight and Enforcement Group (MOEG). As a Health Insurance Specialist, GS-0107-13, you will evaluate and implement compliance, audit, and oversight requirements, policies, and operating procedures related to activities and processes involved with monitoring and oversight of external CMS stakeholders.

Duties

Lead tasks designed to develop, evaluate, and implement Medicare, Medicaid, CHIP, Marketplace Exchange, and private health insurance programs. Conduct analytical studies and evaluate the effectiveness of program initiatives by gathering, organizing, and interpreting data. Make recommendations supported by facts and background information. Develop and review health care policies and legislation in order to draft related policy documents, regulations, procedures and guidance to states. Attend meetings and conferences with CMS staff and serve as a source of background data on the basis of research performed in preparation for the meetings and conferences. Establish and maintain contacts and working relationships with both internal and external stakeholders required to plan and execute tasks.

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-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: (1) Developing evaluation methods or processes to assess contracted health care plans' program compliance; and (2) Conducting health care entity audits or oversight activities for compliance with contract and program requirements; and (3) Analyzing laws, regulations, and data for continuous improvement of health care oversight programs. 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 Federal employees 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/12556146

Education

This job does not have an education qualification requirement.

Contacts

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