A determination of your minimum qualifications will be based on the requirements listed below. You will be evaluated based upon the experience and/or education reflected in your resume. Please use clear and concise descriptions/examples when describing your experience. Applicants are advised that all information concerning qualifications is subject to investigation. By submitting your application, you are certifying the accuracy of the information contained in your application. If you make a false statement in any part of your application, you may not be hired; you may be terminated after you begin work; or, you may be fined or jailed. ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.
Specialized Experience: Specialized Experience is experience that has equipped the applicant with the particular knowledge, skills, and abilities to perform successfully the duties of the position and is typically in or related to the work of the position to be filled.
For the GS-11 Grade Level: Specialized experience is defined as one (1) year (52 weeks) of specialized experience (equivalent to the grade 9 level in the Federal service) which includes: working in the health insurance and/or health care area preparing replies to correspondence and answering verbal inquiries; reviewing audit findings and resolution of audit exceptions; identifying technical and administrative training needs; reviewing and certifying new applicants; processing re-certifications; using program data to assess and control the timeliness and adequacy of State Agency re-certification actions; and providing technical, clinical, and professional interpretation and application of policies, regulations, and standards.
- 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.
For the GS-12 Grade Level: Specialized experience is defined as one (1) year (52 weeks) of specialized experience (equivalent to the grade 11 level in the Federal service) which includes:working in the health insurance and/or health care area preparing replies to correspondence and answering verbal inquiries; reviewing audit findings and resolution of audit exceptions; identifying technical and administrative training needs; reviewing and certifying new applicants; processing re-certifications; providing technical, clinical, and professional interpretation and application of policies, regulations, and standards; developing, revising, and implementing Standard Operating Procedures related to certification activities; and developing recommendations for enforcement actions to be taken against long term care facilities and other providers and suppliers in accordance with applicable Medicare and Medicaid laws 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.
Foreign Education: If you are using education completed in foreign colleges or universities to meet the qualification requirements, additional supporting documentation is required. Click here for more information about REQUIRED DOCUMENTS.
Conditions of Employment:
1. Security and Background Requirements: If not previously completed, a background security investigation will be required for all appointees. 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 at http://www.opm.gov/forms/pdf_fill/of306.pdf. 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: If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the DHS "E-Verify" System. Federal law requires DHS to use the E-Verify System to verify employment eligibility of all new hires, and as a condition of continued employment obligates the new hire to take affirmative steps to resolve any discrepancies identified by the system. The U.S. Department of Health and Human Services is an E-Verify Participant.
3. Direct Deposit: All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choosing.
HOW YOU WILL BE EVALUATED:
Once the application process is complete, a review of resume and supporting documentation will be made and compared against your responses to the assessment questionnaire to determine if you are qualified for this job. If, after reviewing your resume and or supporting documentation, a determination is made that you have inflated your qualifications and or experience, you may lose consideration for this position. Please follow all instructions carefully. Errors or omissions may affect your eligibility. Category rating procedures will be used to rate and rank candidates. The category assignment is a measure of the degree in which your background matches the competencies required for this position. Qualified candidates will be ranked into one of three categories: Best Qualified, Well Qualified or Qualified.
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. Preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent must be listed in the highest quality category (except in the case of scientific or professional positions at the GS-9 level or higher).
Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):
- Knowledge of Titles XVIII and XIX of the Social Security Act, and guidelines related to the approval of providers and suppliers for participation in the Medicare and/or Medicaid program
- Ability to provide oversight to State Agencies, providers and other stakeholders
- Ability to research and analyze technical information and data and make recommendations
- Ability to communicate verbally
- Ability to communicate in writing
Your résumé and/or supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect your rating or consideration for employment.
NOTE: If you submit a resume but no questionnaire, you will not be considered for the position. If you submit a questionnaire but no resume, you cannot be considered for the position. Your application will be appropriately documented and you will be removed from competition.