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 Plan Payment Group (MPPG), Division of Payment Analysis & Policy (DPAP).

As a Health Insurance Specialist, you will serve provide guidance on complex, cross-cutting legal issues and questions affecting Medicare Advantage (MA) and Part D payment policy.

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) Developing Medicare Advantage and/or Part D regulations, guidance, or sub-regulatory policies, ensuring compliance with statutory authority and administrative law; AND (2) Conducting analyses of legislative, regulatory or policy initiatives to assess impact on Medicare Advantage or Part D programs; AND (3) Providing legal and policy advice on Medicare Advantage or Part D payment policy issues to senior CMS officials, Congress, or external stakeholders; AND (4) Representing CMS in meetings and negotiations with health plans, on legal or contractual issues related to Medicare payment policy.

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/12864866 Major Duties:

• Provide highly specialized legal analysis requiring deep understanding of Medicare Part C and D statutory frameworks, payment methodologies, and regulatory complexities both across MPPG and directly to Center leadership.
• Stay abreast of legal and regulatory changes and emerging legal challenges related to Medicare Part C and D payment policy.
• Develop and draft legislative proposals and recommend policy changes affecting MA and Part D payment policies for potential inclusion in the President's Budget.
• Serve as the principal liaison to internal and external offices, partners, and stakeholders, including the Office of General Counsel (OGC) and other CMS components, on legal issues.
• Respond to inquiries regarding legal issues pertaining to MA and Part D payment policies from a variety of internal and external stakeholders (e.g., beneficiaries, plans, congressional staff, and other government officials).