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), Medicare Drug Rebate and Negotiations Group (MDRNG) in Denver, Colorado, Philadelphia, Pennsylvania, and Woodlawn, Maryland.

As a Health Insurance Specialist, you will develop, evaluate and implement policies related to activities and processes involved with monitoring and oversight of CMS health plans programs.

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-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) Modifying, developing, or maintaining oversight processes of health insurance programs or entities in the prescription drug supply chain; AND (2) Ensuring compliance of healthcare or prescription drug supply operations with health insurance program regulations and policies; AND (3) Conducting reviews to assess program operations for health insurance 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 or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year 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/12858007 Major Duties:

• Serve as an expert in the development, evaluation, and implementation of policies related to activities and processes involved with the monitoring and oversight of external CMS stakeholders.
• Develop, implement, and maintain operational requirements, a comprehensive program oversight strategy.
• Develop and review health care policies and legislation in order to draft related policy documents, regulations, procedures and guidance.
• Respond to inquiries regarding program oversight activities to a variety of internal and external stakeholders.
• Develop, implement, and maintain operational requirements, including standard operating procedures, as well as databases to manage and analyze programmatic information.