Health Insurance Specialist

Summary

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, Managed Care Group (MCG). As a Health Insurance Specialist, GS-0107-13, serves as an expert in the development, evaluation, implementation, and oversight of Medicaid Managed Care Policy, operations, program integrity, FWA activities within the Group's areas of responsibility.

Duties

• Developing and evaluating Medicaid Managed Care policies by researching statutory requirements, program history, and policy options to support effective program administration and beneficiary services.
• Analyzing proposed legislation, regulations, and policy initiatives to determine impacts on Medicaid Managed Care programs and recommending changes to improve program effectiveness and operations.
• Reviewing state reports, compliance documentation, and managed care policies to assess adherence to federal requirements and verify completion of corrective and enforcement actions.
• Conducting analytical studies of Medicaid policies, procedures, guidance, business processes, and systems to identify operational problems and recommend improvements in efficiency and effectiveness.
• Preparing briefing materials, reports, issue papers, and program guidance and communicating Medicaid Managed Care policies, requirements, and operational issues to internal and external stakeholders.
• Coordinating Medicaid program assignments and projects with internal staff, states, contractors, and health care organizations to resolve issues, develop solutions, and support division priorities.

Qualifications

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-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. Analyzing, developing, and implementing statutes, regulations, or operational requirements governing Medicaid managed care or other comparable national health care plans or programs;2. Providing technical assistance, guidance, and subject-matter expertise to states and other stakeholders on Medicaid managed care requirements or similar national healthcare plans and/or programs to promote compliance with applicable federal statutes, regulations, and program requirements; AND 3. Assessing program integrity risk and impact and developing recommendations and solutions to strengthen program oversight, compliance, and performance. 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. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/13071110

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): 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. You will be placed in one of the following categories based on category rating and selection procedures if you meet all of the requirements outlined in this job opportunity announcement: Best Qualified - for those who are superior in the evaluation criteria Well Qualified - for those who excel in the evaluation criteria Qualified - for those who only meet the minimum qualification requirements If you are found to be among the top-qualified candidates, you will be referred to the selecting official for employment consideration. This is a competitive vacancy announcement advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served, and all other Federal entitlements would remain the same. The category rating process does not add veterans' preference points or apply the "rule of three" but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans' preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher). Other Information

Bargaining Unit Position: Yes-American Federation of Government Employees, Local 1923 Tour of Duty: Flexible Recruitment Incentive: Not Authorized Relocation Incentive: Not Authorized Financial Disclosure: Not Required Atlanta, GA, Locality Pay: $112,556 to $146,325 Dallas, TX Locality Pay: $115,711 to $150,426 Woodlawn, MD Locality Pay: $121,785 to $158,322 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.