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).

As a Health Insurance Specialist, GS-0107-14, you will serve as senior technical advisor to the Director and deputy Director, DPS and to the Hospital and Ambulatory Group on cross-cutting payment policy issues, especially with regard to issues that intersect with physician and other professional payment.

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.

Conducting quantitative and qualitative analyses to support the valuation of services, development of payment rates, and design of incentive structures under large-scale healthcare payment systems (e.g., fee schedules or prospective payment systems); 2.

Designing and executing policy impact analyses supporting evidence-based recommendations for payment policy changes affecting national healthcare programs; AND 3.

Providing data-driven recommendations and executive-level briefings to inform senior leadership decision-making on high-impact initiatives.

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/12932156 Major Duties:

• Advising leadership on complex clinician payment policies, including legislation, strategic planning, alternative payment models, and Medicare Physician Fee Schedule rate setting, providing technical expertise to support major initiatives.
• Acting as a technical expert on physician payment policy, conducting analyses and research on laws and their impacts to develop informed recommendations for senior leadership decision-making.
• Representing senior officials to stakeholders and Congress, explaining and defending payment policies and the qualitative and quantitative analyses behind proposed regulatory, legislative, and program decisions.