Health Insurance Specialist (Program Contract Manager)

Full Job Description

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services (CMCS).

As a Health Insurance Specialist (Program Contract Manager), GS-0107-13, you will serve as an expert in developing, evaluating, and implementing policies for Agency healthcare programs, and propose operational modifications based on healthcare industry changes and beneficiary needs.

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) Providing procurement planning, execution, monitoring and technical assistance for Contracting Officer Representative (COR) activities for a national healthcare program (i.e.

Medicaid, CHIP, Marketplace); (2) Monitoring contractors who support national healthcare programs and maintain related databases, such as master utilization records and history files; (3) Conducting analytical studies by interpreting health care program issues related to contract administration functions; AND (4) Coordinating responses to government inquiries regarding health care program issues requiring corrective action plans.

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/12873689 Major Duties:

• Serve as an expert in the development, evaluation, and implementation of policies related to administering, reviewing and evaluating contracted stakeholders that participate in Agency health care delivery and quality or payment programs.
• Identify and propose modifications to operations to reflect changes or trends in the health care industry program objectives and needs of beneficiaries.
• Evaluate proposed, modified, or new legislation and regulations to assess impact on national health delivery, quality, or payment programs.
• Analyze internal policies, processes, and procedures to assure increased efficiency in operations and implement those policies, procedures, and processes to resolve problems and improve internal operations.
• Identify vulnerabilities in program requirements, implement instructions and guidelines to safeguarding program expenditures.