This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation(CMMI). As a Health Insurance Specialist, GS-0107-12, 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 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-12, 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-11 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Participating in teams or work groups for healthcare programs including conducting analysis of national or state health insurance program policy issues in order to propose policy modifications; 2) Presenting recommendations and conclusions based on analysis and evaluation of health insurance programs that describe feasible options or consequences; AND 3) Presenting health insurance or related information to various levels of management, their representatives and/or staff. 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 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/12845044
Develop, implement, and maintain a comprehensive program oversight strategy and processes for overseeing entities that provide health care and prescription drug services.
Develop or revise materials and tools to assess participating entities compliance with requirements of Agency programs.
Monitor entities processes to identify program vulnerabilities and ensure that continuing compliance with Agency agreements/contracts and all statutory, regulatory and sub-regulatory requirements are met.
Develop, evaluate, and refine regulations, manuals, program guidelines, program memoranda, policy letters and instructions to disseminate and effectively communicate policy to Agency internal and external stakeholders.