Health Insurance Specialist (Program Oversight)
What you'd do
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare. As a Health Insurance Specialist, referred here as a Health Insurance Specialist (Program Oversight), GS-0107-13, you will be responsible for developing, evaluating and implementing requirements, policies, and operating procedures for monitoring, compliance, and oversight activities related to Medicare and external CMS stakeholders.
Major duties
Serve as an expert in the development, evaluation, and implementation of Medicare, Providers and Private Health Plans. Develop, implement, and maintain operational requirements and comprehensive program oversight strategy that provide health care and prescription drug services, Develop and review health care policies and legislation in order to draft related policy documents, regulations, procedures and guidance to states. Gathers and analyzes information, conducts various reviews and studies to assess ongoing operations, program vulnerabilities and initiate and/or recommend improvements or appropriate action to ensure compliance.
What you need to qualify
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-0107-13 position, 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) Modifying, developing, or maintaining oversight processes of national health insurance programs such as Medicare or entities in the prescription drug supply chain; (2) Ensuring compliance of healthcare or prescription drug supply operations with national health insurance programs such as Medicare regulations and policies; AND (3) Conducting reviews to assess program operations for health insurance programs such as Medicare regulations and guidance. 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/13000556
Before you apply
Federal applications are different: your resume should be 3–5 pages and mirror the language of this announcement. Read our federal resume guide first — it's the #1 reason qualified people get screened out.
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