Health Insurance Specialist (Data Analysis & Studies)

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare (CM), Medicare Plan Payment Group (MPPG), Division of Payment Reconciliation (DPR). As a Health Insurance Specialist, referred here as a Health Insurance Specialist (Data Analysis & Studies), GS-0107-13, you will perform data analysis and lead studies and projects related to Medicare programs.

Duties

• •Design, plan, and conducts complex data analyses and studies supporting Medicare Part D operations/policy and Part C enrollment and encounter data operations/policy/
• •Validate and interpret program data; identifies trends, disparities, data-quality issues, and operational risks; and develops technically sound recommendations.
• •Research and analyze policy issues, laws, regulations, and program requirements and evaluates operational and data implications.
• •Lead cross-functional project to improve data quality, business practices, operational requirements, reporting, and program performance.
• •Prepare reports, metrics, briefings, presentations, and recommendations and work with stakeholders to resolve complex program and data issues.

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) Designing data studies to evaluate the impact of operations and policies on health insurance programs, including Medicare Advantage (Part C) or Part D; (2) Using qualitative and quantitative techniques to identify trends, root causes, and contributing factors affecting health insurance programs or healthcare administration; (3) Interpreting statute and federal regulations governing Medicare Parts C or D to assess program compliance or inform policy decisions; AND (4) Developing summary reports, briefings, or policy statements to explain qualitative and quantitative data from studies. 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 or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year 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/13084521