Health Insurance Specialist

Summary

Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Financial Management, Payment Accuracy and Reporting Group (PARG). As a Health Insurance Specialist, GS-0107-13, you will serve as the primary CMS focal point for functional administration and oversight of the Comprehensive Error Rate Testing (CERT) Program, and for internal and external reporting of CMS's Medicare FFS improper payment activities.

Duties

Provide expert policy analysis and technical guidance on the Payment Integrity Information Act (PIIA) and Medicare Fee-for-Service (FFS) improper payment measurement program, ensuring consistent interpretation of legislation, regulations, coverage policies, and billing requirements. Guide CMS contractors and Medicare Administrative Contractors (MACs) in implementing program policies, reviewing improper payment reports and reduction strategies, and educating stakeholders on compliance and reporting requirements. Develop, implement, and evaluate program initiatives to improve operational efficiency, identify root causes of improper payments, mitigate risks, and recommend policy and procedural improvements. Conduct special studies, comparative analyses, and program evaluations to assess payment integrity, identify emerging trends, validate analytical models, and determine the feasibility of large-scale reviews and audits. Prepare regulations, sub-regulatory guidance, briefing materials, congressional reports, and financial reporting content; advise CMS leadership, represent the agency before stakeholders, and coordinate responses to complex program inquiries. 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-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: Providing support to improper payment measurement contractors on Medicare Fee-for-Service (FFS) policies and requirements; AND, Communicating to the public or medical professionals on the coverage policies related to the items and services that are eligible for payment under Medicare FFS rules; AND, Educating providers, beneficiaries, and stakeholders on compliance, billing, reporting, or other operational aspects of the Medicare FFS program; AND, Preparing briefing materials or reports, such as contributing to the Payment Integrity Report section of the annual Agency Financial Report (AFR) and compiling supplemental improper payment data for program oversight and transparency. 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/13094438

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 will 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): Attention to Detail Customer Service Decision Making Flexibility Integrity/Honesty Interpersonal Skills Learning Reading Comprehension Self-Management Stress Tolerance Teamwork 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: Yes Tour of Duty: Flexible Recruitment Incentive: Not Authorized Relocation Incentive: Not Authorized Financial Disclosure: Not Required 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.