This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM), Division of Part D Policy (DPDP). As a Health Insurance Specialist, GS-0107-14, you will develop, evaluate, and implement Medicare prescription drug benefit policies.

Duties

Serves as a health insurance resource providing expert guidance on the development of coordination of benefits (COB) policies and operations with Part D organizations and other secondary payers. Conducts program-related studies and data analysis regarding the Medicare drug prescription benefit: program oversight and program policy that provides decision-makers with quantitative and qualitative data and analysis for program management. Reviews technical pharmacy transaction standard changes to ensure they meet the needs of the Part D program and works with members to ensure agency priorities are addressed within the standards. Advises high-level management officials regarding the operations, health policies, legislation or regulation, and special projects of the Medicare drug prescription benefit program. Develops technical responses to correspondence concerning the impact of program policies and data collection on Federal financing programs to the health care industry, program beneficiaries, pharmacy transaction, 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.

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. In order to qualify for the GS-14, 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-13 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Interpreting Medicare and Prescription Part D Secondary Payer statute and regulations to create coordination of benefits policies and procedures; AND 2) Reviewing technical pharmacy transactions standard changes to ensure Medicare Part D program compliance; AND 3) Identifying potential improvements or changes for the Medicare Part D program and making recommendations to implement such solutions; AND 4) Communicating technical and detailed information in a variety of formats such as regulations, briefing papers, presentations, meetings, etc. 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/12554083

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]