Health Insurance Specialist

Centers for Medicare & Medicaid Services•Woodlawn, MD

21d

About The Position

This position is with the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Financial Management, Payment Accuracy and Reporting Group, Division of Medicare Advantage and Drug Error Rate. The Health Insurance Specialist, GS-0107-12, develops, evaluates, and implements compliance, audit, and oversight requirements, policies, and operating procedures. The role supports Medicare Part C and D program oversight, including improper payment measurement and reporting, contractor oversight, and responses to stakeholder inquiries.

Requirements

U.S. citizen or national.
At least one year (52 weeks) of specialized experience equivalent to the GS-11 grade level in the Federal government, acquired in the public or private sector.
Experience analyzing and interpreting federal health insurance laws, regulations, and policies, such as those governing Medicare Part C and D, to evaluate program operations, identify improper payment vulnerabilities, or recommend improvements to payment accuracy measurement programs.
Experience applying program payment policy to identify improvements or refine methodology for evaluating program operations in an improper payment measurement program.
Experience using project management tools and techniques to plan, conduct, or evaluate improper payment measurement programs and deliverables to ensure timely measurement and reporting.
Meet all qualification requirements within 30 days of the announcement closing date.
Submit a resume of no more than two pages with detailed information about relevant responsibilities and specialized experience.
Current or former Federal employees, and current or former Federal employees applying under VEOA who held a permanent General Schedule position in the previous year, must have served at least 52 weeks at the next lower grade level.
Subject to a background and suitability investigation.
Male applicants born after December 31, 1959, must be registered or exempt from Selective Service.
A one-year probationary period may be required.
Federal employees must receive salary payments by direct deposit.

Responsibilities

Research Part C and D program issues and develop responses.
Assist in preparing briefing materials and reports.
Oversee contractors to ensure timely production of annual Medicare Part C and D improper payment rates.
Provide subject matter expertise in reviewing contractor issues, evaluating budget issues, and addressing other contractual matters, including reviewing statements of work, proposals, and independent government cost estimates.
Respond to inquiries regarding program oversight activities from internal and external stakeholders, including beneficiaries, providers, representatives of public and private organizations, congressional staff, and other government organizations.