Supervisory Health Insurance Specialist (Division Director)

Summary

Department of Health & Human Services, Centers for Medicare & Medicaid Services, Center for Medicare, Medicare Enrollment & Appeals Group (MEAG), Division of Appeals Policy (DAP). As a Supervisory Health Insurance Specialist, GS-0107-15, serves as the Division Director with overall responsibility for directing, coordinating, and integrating the functions of staff with the work of other organizations in the Center and throughout the Agency, and/or external-to-CMS groups or interests.

Duties

• Planning and assigning work, establishing priorities, evaluating performance, resolving employee concerns, approving personnel actions, and identifying training and development needs.
• Directing the analysis, development, interpretation, and implementation of legislation, regulations, policies, and procedures governing Medicare appeals, grievances, and beneficiary dispute resolution.
• Overseeing Medicare Advantage and Part D appeals operations involving regional offices, Independent Review Entities, the Office of Medicare Hearings and Appeals, and the Departmental Appeals Board.
• Leading the development and administration of standardized beneficiary notices and policies that safeguard Medicare beneficiary rights, protections, and financial liability requirements.
• Developing and approving manual instructions, rulings, change requests, technical direction letters, and policy guidance concerning appeals, grievances, and dispute resolution processes.
• Representing CMS before HHS, OMB, congressional staff, federal agencies, contractors, health plans, provider organizations, beneficiary groups, and other stakeholders.
• Evaluating division operations, implementing process improvements, recommending staffing and budget resources, and ensuring work products meet established quality, timeliness, and regulatory requirements.
• Coordinating with CMS components, legal counsel, adjudicatory entities, and technology teams to resolve operational issues and improve Medicare appeals systems and workflows.

Qualifications

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-15 , 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-14 grade level in the Federal government, obtained in either the private or public sector, to include: 1. Overseeing work activities of teams responsible for implementing federal healthcare programs; 2. Directing the development of regulatory proposals and sub-regulatory guidance for federal healthcare policy; And 3. Collaborating with provider groups, managed care and prescription drug plans, Medicare contractors, States, and other stakeholders on continuous improvement of healthcare 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 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/13055949

How You Will Be Evaluated

You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), the responses you provide on the application questionnaire, and the results of the online assessments required for this position. A Subject Matter Expert may assist in the resume review process to help determine whether you meet the minimum job qualifications. Please follow all instructions carefully. Errors or omissions may affect your rating. You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics): Accountability Customer Service Decisiveness Flexibility Interpersonal Skills Problem Solving Resilience In order to be considered for this position, you must complete all required steps in the process. In addition to the application and application questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job. Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on the online assessment may also result in your removal from consideration. Other Information

Bargaining Unit Position: No Tour of Duty: Flexible Recruitment Incentive: Not Authorized Relocation Incentive: Not Authorized Financial Disclosure: OGE-450 Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement. CMS offers flexible working arrangements and allows employees the opportunity to participate in alternative work schedules at the manager's discretion. The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.