Health Insurance Specialist

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Financial Management. As a Health Insurance Specialist, GS-0107-13, you will lead CMS debt collection, payment, contractor oversight, and financial management activities to support accurate and timely Medicare operations.

Duties

• •Manages and monitors demonstration allowances and expenditures.
• •Maintains DFSDM payment records, receivables, and monitoring of Fee-for-Service (FFS) and demonstration funds usage through HIGLAS reports.
• •Verifies funds availability and adequacy for payment demands.
• •Plans, develops, coordinates, implements, and operates payment systems for demonstration/model projects under Medicare, Medicaid, and/or the Children's Health Insurance Program.
• •Conducts Quality Assurance Surveillance Program (QASP) reviews on MAC debt management activities.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume (limited to no more than 2 pages) 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 being considered further. 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) Coordinating with stakeholders on overpayment, recoupment, or debt-collection activities in compliance with financial policies and regulations; 2) Supporting payment or reimbursement activities, including tracking funds, processing payments, and preparing supporting documentation; and 3) Serving as a point of contact with contractors to oversee debt-management activities and support timely collections. Selective Placement Factor(s): Selective placement factors are applied in the same manner as minimum qualification requirements. Relevant selective placement factor experience must be well documented in your resume. Failure to meet a selective placement factor will result in you not receiving further consideration. In addition to the minimum qualifications described above, you must meet the following selective placement factor(s): GS-13 - The incumbent is required to possess and maintain a Contracting Officer Representative (COR) Level I. 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/13072215