Health Insurance Specialist (Technical Advisor)

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), Div of Institutional Claims Processing.

As a Health Insurance Specialist, referred to here as Health Insurance Specialist (Technical Advisor), GS-0107-14, you will serve as a technical authority and program expert in the work of the Division, as a key resource for PBG and CM management on the full range of institutional claims processing issues.

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.

Analyzing Medicare institutional claims policies and implement them in Fiscal Intermediary Shared System (FISS); 2.

Interpreting Medicare claims processing issues impacting FISS and provide solutions to leadership; AND 3. Leading claims processing projects and provide technical guidance to team members.

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/12877990 Major Duties:

• Function as the principal original Medicare institutional technical specialist for inpatient hospital claims leading cross-functional from the same or other components.
• Lead studies that analyze the efficiency, effectiveness, and/or improvement of Medicare operational policy and program operations that impact services provided by contractors and/or providers to beneficiaries.
• Represent the Division, Group, and Center in resolving technical claims processing issues involving original Medicare institutional claims processing requirements, policy, common working file and standard systems capabilities and program objectives.
• Evaluate proposed legislation, policy suggestions, or proposals for innovative delivery models for impact on Medicare FFS claims systems and institutional providers.
• Translate legislative language (e.g., statutory text, conference report information) into specific program goals, actions, and business rules to direct contractor staff in order to reflect statutory changes in MAC claims processing.