This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM), Medicare Enrollment & Appeals Group (MEAG), Division of Appeals Operations (DAO). As a Health Insurance Specialist, GS-0107-13, you will serve as Contracting Officer's Representative (COR) for Medicare appeals-related contracts and coordinate resolution of operational and quality assurance issues.

Duties

Serve as Contracting Officer’s Representative (COR) for Medicare appeals-related contracts and coordinates resolution of operational and quality assurance issues with relevant CMS components. Provides direction to regional offices and Medicare contractors on appeals procedures and on developing solutions to specific issues as they arise during a contractor's processing of beneficiary or provider requests for appeal. Prepares written products, such as operational instruction, manual material, correspondence, and presentations, to effectively provide guidance on operations for the Medicare fee-for-service appeals process. Serves as an operational consultant in identifying management's information needs for data relating to Medicare fee-for-service appeals and recommends actions for establishing or modifying the reporting and information systems.

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 this GS-13 position, you must clearly 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) Analyzing data, policies, or operational requirements to administer the appeals process for Medicare claims; AND (2) Developing or evaluating Medicare appeal policies or contracts; AND (3) Leading projects or teams related to Medicare appeals; AND (4) Providing technical direction to internal and external customers on the appeals process. 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/12634756

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]