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HEALTH INSURANCE SPECIALIST

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Job Description

Position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare, Division of Appeals Operations (DAO), Medicare Enrollment & Appeals Group (MEAG). As a HEALTH INSURANCE SPECIALIST, GS-0107-14, you will serve as a technical authority and program expert providing high-level technical expertise on cross-cutting operational activities to include the following areas: Medicare Parts A,B, C, & D claim appeals and grievances.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume 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 receiving further consideration. In order to qualify for the GS-14 , 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-13 grade level in the Federal government, obtained in either the private or public sector, to include: Negotiating or collaborating with staff to provide guidance on applying contract administration principles to Medicare claim appeals contract oversight work; Developing budget projections, requests, or presentations related to budget and financial issues regarding the Medicare claim appeals process; AND Interpreting or applying Medicare claim appeals laws, regulations, policies, standards, or procedures to address acquisition issues or explain processes, orally or in writing, to the appropriate audience. COR III Certification Required - You MUST possess and maintain a COR III certification for this position. (Note: Documentation demonstrating that you possess your COR III Certification must be uploaded at time of application.) 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 Federal employees 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/12803353

Required Documents

To apply for this position, you must submit a complete Application Package which includes: 1. Resume showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://help.usajobs.gov/faq/application/documents/resume/what-to-include. 2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Current CMS employees are REQUIRED to submit a copy of their most recent Notification of Personnel Action (SF-50) at the time of application. Additional documents may also be required to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration. 3. COR III Certification Required - You MUST possess and maintain a COR III certification for this position. Applicants are REQUIRED to submit a copy of their certification at the time of application. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration. 4. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments if you received the link after the close of the announcement. To determine if you need a RA, please click here to review the Procedures for Requesting a Reasonable Accommodation for Online Assessments. PLEASE NOTE: A complete application package includes the online application, resume, and CMS required documents. Please carefully review the full job announcement to include the "Required Documents" and "How to Apply" sections. Failure to submit the online application, resume and CMS required documents, will result in you not being considered for employment.

Department Information

Agency

Centers for Medicare & Medicaid Services

Department

Department of Health and Human Services

Location

Woodlawn, Maryland, Maryland, United States

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HEALTH INSURANCE SPECIALIST - USA Jobs