Job Summary of Health Insurance Specialist:
Become a part of the Department that touches the lives of every American! At the Department of Health and Human Services (HHS) you can give back to your community, state, and country by making a difference in the lives of Americans everywhere. It is the principal agency for protecting the health of citizens. Join HHS and help to make our world healthier, safer, and better for all Americans.
This Health Insurance Specialist position is with the Division of Medicare Debt Management, Financial Services Group, Office of Financial Management, Center for Medicare and Medicaid Services, Baltimore (Woodlawn), MD.
This is a competitive Health Insurance Specialist vacancy, open to all United States citizens, advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointment to the civil service. Current civil service employees would therefore be given new appointments to the civil service. Applications are also accepted from current members of the Commissioned Corps and Certain Military Spouse.
PHS Commissioned Corps Officers interested in performing the duties of this position within the Commissioned Corps (not as a career/career-conditional employee) are encouraged to apply under the merit promotion announcement indicated above.
Additional selections may be made from this announcement.
- Interprets statutes to produce federal regulations, policy statements, and other program guidance; application of program policy to identify and resolve program issues; and develops and reviews of statute, regulations, policy documents, Medicare contractor policy issuances, Medicaid State Agency (SA) policy, and similar documents in order to establish compliance benchmarks and procedures. Health Insurance Specialist Implements regulations for Medicare, Medicaid, CHIP and/or other health insurance programs. Researches and determines potential reductions to amount due and owing for violations of Section 1877 of the SSA disclosed in accordance with the Self-Referral Disclosure Protocol (SRDP).
- Health Insurance Specialist Develops policy, procedures, and operational guidance specific to matters related to the aforementioned Acts as well as other regulations related to Medicare health policy and programs. Works with Medicare contractors, attorneys, hospital CEO’s and CFO;s, the Office of General Counsel, the Department of Justice, and States to ensure compliance with Medicare laws, regulations, and operations. Works with Medicare contractors, States, other key stakeholders, and leadership to identify and address evolving program issues or provide guidance on operational/programmatic matters. Issues operational policies for Medicare programs.
- Health Insurance Specialist Reviews and evaluates information submitted under the SRDP to ensure compliance with Federal regulations. Interprets statutes, reviews violations, makes recommendations as to the amounts due and owing the Medicare Program for violations of Section 1877 of the SSA based on the authorities granted by Section 6409 of the PPACA. Prepares descriptions of violations, settlement agreements, and justifications of financial analysis and review methodologies for reducing amounts due and owing the Medicare program. Health Insurance Specialist Assists in the development of policies and processes related to Medicare overpayments and debt collection activities. Manages and oversees implementation and operations of various technical and administrative projects. May serve as a Contracting Officer Technical Representative (COTR).
KEY REQUIREMENTS of Health Insurance Specialist job:
- U.S. Citizenship is required.
- You must meet minimum qualifications stated on the announcement.
- Background and/or security investigation required.
- Be sure to read the “How to Apply” section for all required documents
- You may be required to complete 1 year probationary period.
SALARY RANGE: $89,033.00 – $115,742.00 /year
SERIES & GRADE: GS-0107-14
POSITION INFORMATION: Full Time Career/Career Conditional
PROMOTION POTENTIAL: 14
DUTY LOCATIONS: 1 vacancy – Baltimore Metro area, MD
WHO MAY BE CONSIDERED: United States Citizens
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