Job Information
Centers for Medicare & Medicaid Services Health Insurance Specialist (Claims Processing & Systems) in Woodlawn, Maryland
Summary 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), Business Services Group (BSG). As a Health Insurance Specialist (Claims Processing & Systems), GS-0107-13, you will perform claims processing and systems work related to national health insurance programs, such as Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and private health insurance. Responsibilities Serve as an expert in the development, evaluation, and implementation of policies related to claims processing and system work. Perform Medicare claims processing, claims reviews, and the adjudication of provider claims to administer and monitor contracts with Medicare contractors. Review and provide analysis for claims/transactions processing activities, claims reviews, and program claims related processing systems used to make payments to providers/suppliers/insurers for the payment of covered services to beneficiaries. Develop and review healthcare policies and legislation in order to draft related policy documents, regulations, procedures and guidance to states. Prepare all forms of written correspondence regarding claims processing, and Medicare program issues to the public, Congressional staff, industry contacts, and State representatives. Requirements Conditions of Employment Qualifications ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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-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: Evaluate claims processing system functions related to quarterly release updates for Medicare Fee For Service claims; AND Develop requirements to process claims from suppliers/providers/insurers; AND Implement claims processing policy or related systems. 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/12450538 Education Additional Information Bargaining Unit Position: Yes - American Federation of Government Employees, Local 1923 Tour of Duty: Flexible Recruitment/Relocation Incentive: Not Authorized Financial Disclosure: Not Required Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement; however, CMS offers flexible working arrangements and allows employees the opportunity to participate in telework combined with alternative work schedules at the manager's discretion. This position may be authorized for telework. Telework eligibility will be discussed during the interview process. Supervisory positions must report a minimum 2 times per week and non-Supervisory positions must report a minimum of 2 times per pay period. ?Full-Time Telework Program for CMS Employees: 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/employeeguides/careertransition.asp.