Health Insurance Specialist

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services CMCS, Managed Care Group (MCG). As a Health Insurance Specialist, GS-0107-13, serves as an expert in the development, evaluation, implementation, and oversight of Medicaid Managed Care Policy, operations, program integrity, FWA activities within the Group's areas of responsibility.

Duties

• •Developing and evaluating Medicaid Managed Care policies by researching statutory requirements, program history, and policy options to support effective program administration and beneficiary services.
• •Analyzing proposed legislation, regulations, and policy initiatives to determine impacts on Medicaid Managed Care programs and recommending changes to improve program effectiveness and operations.
• •Reviewing state reports, compliance documentation, and managed care policies to assess adherence to federal requirements and verify completion of corrective and enforcement actions.
• •Conducting analytical studies of Medicaid policies, procedures, guidance, business processes, and systems to identify operational problems and recommend improvements in efficiency and effectiveness.
• •Preparing briefing materials, reports, issue papers, and program guidance and communicating Medicaid Managed Care policies, requirements, and operational issues to internal and external stakeholders.
• •Coordinating Medicaid program assignments and projects with internal staff, states, contractors, and health care organizations to resolve issues, develop solutions, and support division priorities.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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. Analyzing, developing, and implementing statutes, regulations, or operational requirements governing Medicaid managed care or other comparable national health care plans or programs;2. Providing technical assistance, guidance, and subject-matter expertise to states and other stakeholders on Medicaid managed care requirements or similar national healthcare plans and/or programs to promote compliance with applicable federal statutes, regulations, and program requirements; AND 3. Assessing program integrity risk and impact and developing recommendations and solutions to strengthen program oversight, compliance, and performance. 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/13071110