Health Insurance Specialist

Full Job Description

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM),Division of Appeals Operations (DAO), Medicare Enrollment & Appeals Group (MEAG).

As a Health Insurance Specialist, GS-0107-14, you will serve as a technical authority and program expert providing high-level technical expertise on cross-cutting operational activities in the following areas: Medicare Parts A,B, C, & D claim appeals and grievances.

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.

Your resume (limited to no more than 2 pages) 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 being considered further.

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) Supporting Medicare appeals contract administration by collaborating with CORs, providing guidance, and technical direction to contract oversight work; 2) Developing and presenting budget projections, acquisition plans, or spending reports for Medicare appeals operations; AND 3) Applying Medicare appeals regulations to resolve operational and contractual issues and communicating requirements to CMS staff, contractors, and stakeholders.

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/12875582 Major Duties:

• Provide Medicare claims appeals operational guidance and develop solutions to resolve complex programmatic and/or operational issues to peers and contractors on acquisitions, budget, and programmatic issues.
• Lead activities that provide operational guidance to Medicare claim appeals adjudicators, such as Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs),and improve relations with our partners.
• Operate as the senior advisor for Contracting Officer’s Representatives (CORs) and provides guidance on contract oversight, such as statement of work modifications, technical direction, contractor evaluation, and budgeting.
• Prepare program operations budget, manage the acquisition schedule, and track spending.
• Represent CMS in conferences and technical discussions with professional, public, and private organizations, to further the understanding of critical issues, present to the agency’s position.