Health Insurance Specialist

Centers for Medicare & Medicaid Services • Woodlawn, MD

10d

About The Position

This position is in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM), Division of Acute Care (DAC). The Health Insurance Specialist, GS-0107-14, serves as a technical expert and principal advisor to the DAC Director and Deputy Director, providing high-level technical and conceptual expertise in policy development and analysis, data management, quantitative analyses, and policy implementation.

The specialist advises senior leaders on Inpatient Prospective Payment System (IPPS) policy, strategic initiatives, payment system refinements, and legislative impacts. The role oversees quality assurance for inpatient valuation data, modeling, and policy analysis; coordinates IPPS rulemaking; leads teams and projects; directs analysts; and supports the implementation of inpatient payment policies. The specialist also develops policy options, conducts impact analyses, applies research and new concepts to long-range payment projects, and provides technical assistance and training to CMS, HHS, and congressional staff. The position may represent CMS in discussions with officials, Congress, and stakeholders and may act for the Division Director or Deputy Director as needed.

Requirements

• At least one year (52 weeks) of specialized experience equivalent to the GS-13 grade level in the Federal government, obtained in the private or public sector.
• Experience developing or revising Medicare payment policies, regulations, or sub-regulatory guidance to implement statutory or programmatic requirements.
• Experience leading projects involving Medicare payment policy development or implementation to resolve payment issues.
• Experience conducting policy and data analyses to inform Medicare payment policy decisions.
• Experience preparing briefing materials, policy papers, or presentations to communicate Medicare payment policy information to senior leadership.
• U.S. citizenship or national status is required.
• Must meet applicable time-in-grade restrictions; current Federal employees must have served at least 52 weeks at the next lower grade level.
• Must meet all qualification requirements within 30 days of the announcement closing date.
• A resume of no more than two pages must document relevant responsibilities and specialized experience.
• Selected candidates are subject to a background and suitability investigation.
• A one-year probationary period may be required.
• Males born after December 31, 1959, must be registered with Selective Service or exempt.
• Federal employees must receive salary payments by direct deposit.

Responsibilities

• Serve as an IPPS payment expert, analyzing policy and data to shape Medicare hospital payment rates, incentives, and legislative impacts.
• Advise senior leadership on IPPS policy, strategic initiatives, and payment system refinements.
• Oversee quality assurance for data, modeling, and policy analysis related to inpatient valuation.
• Lead IPPS rulemaking coordination and teams, direct analysts, advise leadership, and act for the Division Director or Deputy Director as needed.
• Advise DAC payment teams on policy and technical issues and lead work structure and development.
• Present policy options to senior leaders and represent CMS in discussions with officials, Congress, and stakeholders as appropriate.
• Conduct impact analyses of proposed policies and payment rates, evaluating emerging and existing policies.
• Apply research and new concepts to long-range inpatient payment projects to support senior policy makers' decisions.
• Coordinate implementation of inpatient payment policies and lead related projects.
• Serve as a resource to CM, CMS, HHS, and congressional staff; advise leadership on legislative impacts; and provide technical assistance and training.

Benefits

• Comprehensive federal employee benefits package, with benefits available to employees and their families; specific eligibility depends on position type.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed