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Health Insurance Specialist

Company Name:
Department Of Health And Human Services
United States Citizens Permanent Full Time The Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) works in partnership with the entire health care community to improve quality and efficiency in an evolving health care system and provides leadership in the broader health care marketplace.
CMS' effectiveness depends on the capabilities of a dedicated, professional staff that is committed to supporting these objectives. A career with CMS offers the opportunity to get involved on important national health care issues and be part of a dynamic, fast-paced, and highly visible organization. For more information on CMS, please /.
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), Data Sharing & Partnership Group (DSPG), Division of Policy & External Partnership in Woodlawn, MD.
WHO MAY APPLY: This is a competitive vacancy, open to all United States Citizens or Nationals, 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.Click here for more information and definitions regarding applicants who may apply to this vacancy announcement.
This vacancy is also being announced concurrently with vacancy announcement CMS-CPI-MP-14-1148240 under merit promotion procedures. If you wish to be considered under both announcements, you must apply separately to each announcement.
PHS Commissioned Corps Officers interested in performing the duties of this position within the Commissioned Corps are encouraged to apply under the merit promotion announcement indicated above.
Additional selections may be made from this announcement for similar positions within CMS in the same geographical location.
You must be a U.S. Citizen or National to apply for this position You will be subject to a background and suitability investigation A one-year probationary period may be required upon appointment
Working in the Division of Policy & External Partnership, you will serve as a Health Insurance Specialist in the development and implementation of Medicare and/or Medicaid program integrity policies. Specifically you will:
Conduct analyses and special studies of policy issues related to Medicare and/or Medicaid program integrity.
Assess the impact of legislation and regulations on the Medicare and/or Medicaid Program Integrity program.
Conduct studies to improve the design and management of Medicare and/or Medicaid program integrity strategies.
Work with internal and external stakeholders to resolve issues with Medicare and/or Medicaid program integrity policy.
ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.
In order to qualify for the GS-9, you must meet the following: You must demonstrate in your resume at least one (1) year of qualifying specialized experience equivalent to the 7 grade level in the Federal Government to include: Assisting in developing projects to improve healthcare operations; and reviewing documents to be used by senior staff.
- OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS 9 level by possessing a Master''s or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related to the position being filled.
- OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-7 grade level may be used to qualify applicants for positions at grades GS-9. Therefore, only education in excess of 1 full year of graduate level education may be used to combine education and experience.
TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see "REQUIRED DOCUMENTS" section below on what documentation is required.
In order to qualify for the GS-11, you must meet the following: You must demonstrate in your resume at least one (1) year of qualifying specialized experience equivalent to the 9 grade level in the Federal Government to include: Evaluating health insurance policies to assist in drafting procedures or instructions and researching health insurance policy.
- OR - Substitution of Education for Experience: You may substitute education for specialized experience at the GS 11 level by possessing 3 full years of progressively higher level graduate education leading to such a degree or Ph.D. or equivalent doctoral degree or LL.M., if related to the position being filled.
- OR - Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-9 grade level may be used to qualify applicants for positions at grades GS-11. Therefore, only education in excess of a master''s or equivalent graduate degree; 2 full years of progressively higher level graduate education leading to such a degree, may be used to combine education and experience.
TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of education and experience. Please see "REQUIRED DOCUMENTS" section below on what documentation is required.
In order to qualify for the GS-12, you must meet the following: You must demonstrate in your resume at least one (1) year of qualifying specialized experience equivalent to the 11 grade level in the Federal Government to include: Analyzing the impact of new policy or legislation on health insurance operations; and representing the organization at meetings/conferences to explain Medicare, Medicaid, or health insurance rules and regulations.
Substitution of Education for Experience: There is no substitution of education for specialized experience at this grade level.
Combination of Experience and Education: There is no combination of experience and education for this grade level.
Click the following link to view the assessment questionnaire:View Assessment Questions
Conditions of Employment:
1. Security and Background Requirements: If not previously completed, a background security investigation _will be required for all selectees_. Appointment will be subject to the applicant''s successful completion of a background security investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a background security reinvestigation or supplemental investigation may be required at a later time. Applicants are also advised that all information concerning qualifications is subject to investigation. False representation may be grounds for non-consideration, non-selection and/or appropriate disciplinary action.
Optional Form 306 - Declaration of Federal Employment - available . This form is not required to be submitted at the time of submitting your application. However, if selected, this form will be required prior to final job offer.
2. E-Verify: The Centers for Medicare and Medicaid Services 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.Click here for more information.
3. Selective Service: Male applicants born after 12/31/1959 must have registered for the Selective Service. Click here for more information.
4. Direct Deposit: All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choosing.
If you meet the minimum qualifications for this position, your application and responses to the online 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, but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans with a service connected disability of 10% or more will be placed at the top of the Best Qualified category (except for professional and scientific positions at the GS-9 level or higher).
Your application will be evaluated based on your ability to demonstrate the following knowledge, skills and abilities/competencies:
Medicare/Medicaid Program Integrity Rules/Regulations
Analytical Ability
Interpersonal Skills
Written Communication
To apply for this position, you must complete the occupational questionnaire and submit the documentation specified in the Required Documents section below. The complete application package (to include resume, occupational questionnaire, transcripts and other applicable supporting documents) must be received by 11:59 PM ET on Wednesday, July 09, 2014 to receive consideration.
To begin, click _Apply Online_ to create a USAJOBS account or log in to your existing account .
1. Follow the prompts to select your USAJOBS resume and/or other supporting documents and complete the occupational questionnaire.
2. Click the _Submit My Answers_ button to submit your application package. It is your responsibility to ensure your responses and appropriate documentation are submitted prior to the closing date.
3. To verify your application is complete, log into your USAJOBS account, , select the _Application Status_ link and then select the _ more information _ link for this position. The_ Details_ page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process.
4. To return to an incomplete application, log into your USAJOBS account and click _ Update Application _ in the vacancy announcement. _You must re-select your resume and/or other documents from your USAJOBS account or your application will be incomplete._
If you complete the occupational questionnaire online and are unable to upload transcripts or supporting document(s), you may fax the document .
To fax your documents, you must use the following cover and provide the required information. The Vacancy ID is1148261.
Fax your supporting documents to .
You are encouraged to apply online. Applying online will allow you to review and track the status of your application. If you cannot complete the Application Package online, you may fax all of your materials. The complete application package must be received by 11:59 PM ET on 1148261 to receive consideration. Keep a copy of your fax confirmation in the event verification is needed. If you applied online and your application is complete, do not fax the paper application (1203FX) as this will overwrite your prior online responses and may result in you being found ineligible.
To complete the occupational questionnaire and submit complete application package via fax:
Click the following link to view and print the full occupational assessment questionnaireView Occupational Questionnaire;
Click the following link to view and print the 1203FX form to provide your response to the assessment ; and
Fax the completed 1203FX form along with any supporting documents to . Your 1203FX will serve as a cover page for your fax transmission.
This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to the CMS HR Helpdesk( ). You may also contact the CMS HR Helpdesk at or . Individuals who are deaf or hard-of-hearing should contact the CMS HR Helpdesk via using of your relay service provider (Video Relay Services or Teletype Services). The decision to grant reasonable accommodation will be made on a case-by-case basis.
_PLEASE NOTE:_ Submission of a resume alone IS NOT a complete application package. This position requires the completion of the assessment questionnaire, transcripts and submission of supplemental documents, as described under the "Required Documents" section of this announcement. Please carefully review the complete job announcement and the "How to Apply" instructions. Failure to provide the required information and/or documents will result in you not being considered for employment.
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 should also list your educational and work experience including the dates (mm/dd/yy or mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, please include the 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 .
2. A complete Occupational Questionnaire.
3. College Transcripts. Although this position does not require a degree, you may substitute college credit in whole, or in part, for experience at specified grade levels. You must submit a copy of your transcript in order to substitute your education for the required experience. If you do not submit a transcript, your education will not be considered in determining your qualifications for the position. You may submit an unofficial transcript or a list of college courses completed indicating course titles, credit hours, and grades received. An official transcript is required if you are selected for the position.
College Transcripts and Foreign Education: Applicants who have completed part or all of their education outside of the U.S. must have their foreign education evaluated by an accredited organization to ensure that the foreign education is comparable to education received in accredited educational institutions in the U.S. For a listing of services that can perform this evaluation, visit the National Association of Credential Evaluation Serviceswebsite. This list, which may not be all inclusive, is for informational purposes only and does not imply any endorsement of any specific agency.
4. Supporting Documents, if applicable (e.g., SF-50, DD-214, SF-15). Supporting documents may be required in the vacancy announcement. Failure to provide appropriate documentation MAY result in a not qualified rating OR non-consideration.Click here for a detailed description of the required supporting documents. You will be required to submit official documentation prior to receiving a final offer. The agency will then verify the information provided on your application (e.g., veterans'' preference, disability).
Contact Information: CMS HR Center Helpdesk
Phone: or
Email:
Hours of Operation: Monday - Friday from 8:00AM ET to 5:00PM ET (excludes all federal holidays)
Within 15 business days of the closing date, Wednesday, July 09, 2014 you may check your status online atUSAJOBS. We will update your status after each key stage in the application process has been completed. The federal government offers a comprehensive benefits package including vacation, sick leave, holidays, life insurance, health benefits, and participation in the Federal Employees Retirement System. For more information, check outOPM''s Employee Benefits Information.
Tour of Duty: Flexible
Recruitment Incentive: May Be Authorized
Financial Disclosure: Not Required
Veterans' Preference: If you are a veteran claiming veterans'' preference, you must submit a copy of your DD-214 (Member Copy 4) or an official statement (including dates of service and Character of Service) from your command if currently on active duty. If you are a disabled veteran, the widow/widower of a veteran, or the spouse of a disabled veteran claiming veterans'' preference, in addition to the DD-214, you must also submit a Standard Form 15 (Application for 10-Point Veteran Preference) and the required supporting documents listed on that form. For more information on veterans'' preference .
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 appropriate documentation (a copy of the agency notice, your most recent performance rating, and your most recent SF-50 noting current position, grade level, and duty location) and be rated well qualified for this vacancy. Well qualified applicants excel in the evaluation criteria for the position. Additional information about ICTAP and CTAP eligibility is on OPM''s Career Transition Resources website /.
Job Seekers with Disabilities :Click here for more information.

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