Health Insurance Specialist

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Program Operations and Local Engagement(OPOLE). As a Health Insurance Specialist, GS-0107-9/11/12, you will develop, evaluate and implement compliance, audit and oversight requirements, policies, operating procedures related to activities and processes involved with the monitoring and oversight of external CMS stakeholders. 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-09 , you must meet the following: Researching and applying Medicare, Medicaid, Children's Health Insurance Program (CHIP), or Affordable Care Act (ACA) statutes, regulations, or sub-regulatory guidance, particularly related to Medicare institutional payment policy, to assist in supporting formal approval, denial, or compliance determinations under supervisory review; Drafting technical documents to communicate findings and decisions to providers, contractors, or federal partners; Reviewing provider applications, program data, or audit reports to identify potential compliance issues and prepare findings or recommendations for supervisory review.

- OR -

Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 level by possessing a Master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related to the position being filled.

- OR -

Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-07 grade level may be used to qualify applicants for positions at the grade GS-09. Therefore, only education in excess of one full year of graduate-level education may be used to combine education and experience. TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see "Required Documents" section below for what documentation is required at the time of application. In order to qualify for the GS-11 , you must meet the following: Analyzing and applying Medicare, Medicaid, Children's Health Insurance Program (CHIP), or Affordable Care Act (ACA) statutes, regulations, or sub-regulatory guidance, particularly related to Medicare institutional payment policy, to develop formal approval, denial, or settlement determinations; Preparing technical documents to communicate findings and decisions to providers, contractors, or federal partners; Reviewing provider applications, audit findings, or claims data to assess compliance with federal health insurance program requirements and formulate resolution recommendations.

- OR -

Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher level graduate education leading to such a degree or equivalent doctoral degree or LL.M., if related to the position being filled. - OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at the grade GS-11. Therefore, only education in excess of a master's or equivalent graduate degree, or 2 full years of progressively higher-level graduate education leading to such a degree, may be used to combine education and experience. TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see "Required Documents" section below for what documentation is required at the time of application. In order to qualify for the GS-12 , you must meet the following: Applying Medicare, Medicaid, Children's Health Insurance Program (CHIP), or Affordable Care Act (ACA) statutes, regulations, or sub-regulatory guidance, particularly related to Medicare institutional payment policy, to make and defend formal approval, denial, or settlement determinations with minimal supervisory oversight. Developing and finalizing authoritative technical documents to communicate legal and policy findings to providers, contractors, or federal partners, serving as a subject matter resource for less experienced staff; Leading the review and analysis of provider applications, audit findings, or claims data to evaluate compliance with federal health insurance program requirements, identify systemic issues or trends, and formulate actionable resolution recommendations for management consideration. Substitution of Education for Experience: There is no substitution of education to meet the specialized experience requirement at the GS-12 grade level. Combination of Experience and Education: There is no combination of experience and education to meet the specialized experience requirement at the GS-12 grade level. Experience refers to both 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. #J-18808-Ljbffr Centers-For-Medicare-and-Medicaid-Services