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- Health Insurance Specialist, MD, USA

Health Insurance Specialist

Department of Health And Human Services

Woodlawn, MD

$96,970 - $126,062 a year - Full-time, Part-time

Summary
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Federal Coordinated Health Care Office FCHCO, Program Alignment Group, Woodlawn, Maryland.

As a Health Insurance Specialist, GS-0107-13, you will coordinate and manage the development, execution, and evaluation of operations to improve coordination, quality, and cost of care for people dually eligible for Medicaid and Medicare (Medicare-Medicaid enrollees).

Responsibilities
Develop operational policy, procedures and systems related to the establishment, accuracy and disclosure of information to support enrollment, marketing, financing, and the applicaiton process for Medicare-Medicaid enrollee integrated plans.
Serve as a member or leader of various workgroups as assigned, to monitor and improve operational policies related to financing, marketing, appeals, application processes, care transitions, beneficiary satisfaction, and/or payment.
Review and provide technical assistance to, and/or coordinates the activities of multiple CMS components, contractors, state officials, and other stakeholders.
Prepare written products (e.g. regulations, manual material, operational policy letters, training documents, notices, and correspondence) to effectively provide guidance on substantive operational policy.
Travel Required
Occasional travel - You may be expected to travel 10% for this position.

Supervisory status
No

Promotion Potential
13

Job family (Series)
0107 Health Insurance Administration

Requirements

Requirements
Conditions of Employment
You must be a U.S. Citizen or National to apply for this position.
You will be subject to a background and suitability investigation.
Qualifications
ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.

In order to qualify for the GS-13, 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) Develop new program policies, and implements and oversees the operational activities related to the administration of managed care models integrating Medicare Advantage and the Medicare Prescription Drug Benefit Program with Medicaid Managed Care. 2) Analyze and proposes new improvements to the policies, operations, and systems of those individuals who are entitled to both Medicare and Medicaid services. 3) Provide technical assistance to health plans, federal agencies, States, and stakeholders in the interpretation of Medicare-Medicaid rules and regulations through written or oral products.

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.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/10248570
Education
This job does not have an education qualification requirement.

Additional information
Bargaining Unit Position: Yes
Tour of Duty: Flexible
Recruitment Incentive: Not Authorized
Financial Disclosure: Not Required

CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page .

The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents . A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp .

Additional Forms REQUIRED Prior to Appointment:

Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation - A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306 .
Form I-9, Employment Verification and the Electronic Eligibility Verification Program - CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9 .
Standard Form 61, Appointment Affidavits - If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61 .

Additional selections may be made from this announcement for similar positions within CMS in the same geographical location. For Central Office vacancies, the "same geographical location" includes Baltimore, Maryland; Bethesda, Maryland; and Washington, D.C.
How You Will Be Evaluated
You will be evaluated for this job based on how well you meet the qualifications above.

If you meet the minimum qualifications and education requirements for this position, your application and responses to the online occupational questionnaire will be evaluated under Category Rating and Selection procedures for placement in one of the following categories:

Best Qualified - for those who are superior in the evaluation criteria
Well Qualified - for those who excel in the evaluation criteria
Qualified - for those who only meet the minimum qualification requirements
The Category Rating Process does not add veterans' preference points or apply the "rule of three" but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans' preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher).

Once the announcement has closed, your online application, resume, and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.

Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):
Health Insurance
Policy Analysis
Technical Competence
Technical Documentation


This is a competitive vacancy announcement advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same.

Background checks and security clearance
Security clearance
Public Trust - Background Investigation

Required Documents

Required Documents
The following documents are REQUIRED:

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/dd/yy) 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://www.usajobs.gov//faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary 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.

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.

Benefits

Benefits
A career with the U.S. Government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Learn more about federal benefits .


Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time, or intermittent. Contact the hiring agency for more information on the specific benefits offered.

Job posted on 26 July 2018.

Please mention Human Rights jobs while applying for this position.