Health Insurance Specialist (Legal Vertical)

Full Job Description

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation,CMMI, Policy & Programs Group, Division of Alternative Payment Model Infrastructure.

As a Health Insurance Specialist (Legal Vertical), GS-0107-11/12, you will serve as a Health Insurance Specialist, analyzing model development and model maintenance with a specific focus on legal aspects of models.

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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-11, 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-09 grade level in the Federal government, obtained in either the private or public sector), to include: 1.Identifying and analyzing legal issues to develop and present solutions under the guidance of senior staff; AND 2.Drafting regulations, program guidance, legislative proposals, waivers, policy memoranda, or binding agreements (e.g.

contracts between parties, participation agreements, cooperative agreements, etc.); using established templates, prior examples, and direction from senior colleagues.

AND 3.Reviewing laws, legislative history, court decisions, or policies to propose modifications and making recommendations to programs with recommendations reviewed and validated by senior staff or supervisors before being acted upon.

- OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing a Ph.D.

or equivalent doctoral degree or 3 full years of progressively higher level graduate education leading to such a degree or equivalent doctoral degree or LL.M., if related to the position being filled.

- OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at the grade GS-11.

Therefore, only education in excess of a master's or equivalent graduate degree, or 2 full years of progressively higher-level graduate education leading to such a degree, may be used to combine education and experience.

TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education.

Please see "Required Documents" section below for what documentation is required at the time of application.

In order to qualify for the GS-12, 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-11 grade level in the Federal government, obtained in either the private or public sector, to include: 1.Identifying and analyzing legal issues to develop and present solutions; AND 2.Drafting and/or reviewing regulations, program guidance, legislative proposals, waivers, policy memoranda, or binding agreements (e.g.

contracts between parties, participation agreements, cooperative agreements, etc.); AND 3.Reviewing laws, legislative history, court decisions, or policies to propose modifications and making recommendations to programs.

Substitution of Education for Experience: There is no substitution of education to meet the specialized experience requirement at the GS-12 grade level.

Combination of Experience and Education: There is no combination of experience and education to meet the specialized experience requirement at the GS-12 grade level.

Experience refers to both 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. NOTE: A writing exercise may be administered before a final selection is made.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/12923061 Major Duties:

• Developing and implementing CMS Innovation Center models to assist and support staff and leadership toward effectively establishing model designs and policies that are legally sound and meet Center objectives.
• Interpreting statutes and developing, drafting, or reviewing Federal regulations, model governing documentation such as participation agreements and cooperative agreements, program waivers, rulemaking, or amendments/updates to such documents.
• Analyzing legal policy issues and topics in assigned subject areas by researching background information, origin of laws, their intended impact to make effective agreements and policy recommendations to further CMMI's mission and model objectives.
• Review, evaluate, and recommend Medicare, Medicaid, and CHIP policy subject issues to senior leadership, with an emphasis on legal analyses.