This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI), Business Services Group (BSG).
As a Health Insurance Specialist (Claims Processing & Systems), GS-0107-13, you will perform claims processing and systems work related to national health insurance programs, such as Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and private health insurance.
Summary
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI), Business Services Group (BSG).
As a Health Insurance Specialist (Claims Processing & Systems), GS-0107-13, you will perform claims processing and systems work related to national health insurance programs, such as Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and private health insurance.
Serve as an expert in the development, evaluation, and implementation of policies related to claims processing and system work.
Perform Medicare claims processing, claims reviews, and the adjudication of provider claims to administer and monitor contracts with Medicare contractors.
Review and provide analysis for claims/transactions processing activities, claims reviews, and program claims related processing systems used to make payments to providers/suppliers/insurers for the payment of covered services to beneficiaries.
Develop and review healthcare policies and legislation in order to draft related policy documents, regulations, procedures and guidance to states.
Prepare all forms of written correspondence regarding claims processing, and Medicare program issues to the public, Congressional staff, industry contacts, and State representatives.
You must be a U.S. Citizen or National to apply for this position.
You will be subject to a background and suitability investigation.
This is a telework eligible position and reports to a CMS Office on a periodic basis. Requirements to report to the office will vary and can be discussed at the time of interview.
Qualifications
ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.
Your resume 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 receiving further consideration.
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:
Evaluate claims processing system functions related to quarterly release updates for Medicare Fee For Service claims; AND
Develop requirements to process claims from suppliers/providers/insurers; AND
Implement claims processing policy or related systems.
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.
This job does not have an education qualification requirement.
Additional information
Bargaining Unit Position: Yes - American Federation of Government Employees, Local 1923 Tour of Duty: Flexible Recruitment/Relocation Incentive: Not Authorized Financial Disclosure: Not Required
Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement; however, CMS offers flexible working arrangements and allows employees the opportunity to participate in telework combined with alternative work schedules at the manager's discretion. This position may be authorized for telework. Telework eligibility will be discussed during the interview process. Supervisory positions must report a minimum 2 times per week and non-Supervisory positions must report a minimum of 2 times per pay period.
???????Full-Time Telework Program for CMS Employees: CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.
The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.
A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.
How you will be evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), the responses you provide on the application questionnaire, and the result of the online assessments required for this position. Please follow all instructions carefully. Errors or omissions may affect your rating.
You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics):
Analysis
Attention to Detail
Customer Service
Decision Making
Flexibility
Integrity/Honesty
Interpersonal Skills
Learning
Oral Communication
Planning and Evaluating
Reading Comprehension
Self-Management
Stress Tolerance
Teamwork
Written Communication
In order to be considered for this position, you must complete all required steps in the process. In addition to the application and application questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job.
Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration. Cheating on the online assessment may also result in your removal from consideration.
You will be placed in one of the following categories based on category rating and selection procedures if you meet all of the requirements outlined in this job opportunity announcement:
Best Qualified - for those who are superior in the evaluation criteria
Well Qualified - for those who excel in the evaluation criteria
Qualified - for those who only meet the minimum qualification requirements
If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration.
This is a competitive vacancy announcement advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same.
The category rating process does not add veterans' preference points or apply the "rule of three" but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans' preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher).
A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.
To apply for this position, you must submit a complete Application Package which includes:
1. Resume showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates. For work in the Federal service, you must include the series and grade level for the position(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/.
Your resume will be used to validate your responses to the assessment tool(s). We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Determining length of general or specialized experience is dependent on the information provided in the resume. Failure to include ALL of the information listed below on your resume WILL result in a finding of ineligible.
Official Position Title (include series and grade if Federal job)
Duties (be specific in describing your duties)
Employer's name and address
Supervisor name and phone number
Start and end dates in the month and year format (e.g. June 2007 to April 2008)
Full-time or part-time status (include hours worked per week)
Salary
2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.
3. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments, if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable_Accommodations_for_USA_Hire
Please read the entire announcement and all the instructions before you begin an application. To apply for this position, you must complete the initial online application, to include the initial online assessment and submission of the required documentation specified in the Required Documents section. The complete application package must be submitted by 11:59 PM (ET) on 07/05/2024 of the announcement to receive consideration. The application process is as follows:
To begin the application process, click the Apply button. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
Follow the system prompts in USAJOBS to select your resume and supporting documents; review your application package; include personal information; and continue the application process in the USA Staffing agency site.
Answer the questions presented in the online application and attach all necessary supporting documentation in USA Staffing.
Click the Submit Application button prior to 11:59PM (ET) on 07/05/2024.
After submitting an online application, you will be notified whether or not you are required to take additional online assessments through the USA Hire Competency Based Assessment system. This message will be delivered to you via email notification. The email may be routed to your "Spam" or "Junk" folder.
If you are asked to take the USA Hire Competency Based Assessments, you will be presented with a unique URL to access the USA Hire system. Access to USA Hire is granted through your USAJOBS login credentials. Be sure to review all instructions prior to beginning your USA Hire Assessments. Click here for Computer System Requirements.
Note, set aside at least 3 hours to take these assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue at a later time, you can re-use the URL sent to you via email and also found by clicking the Track This Application link located in the application record in your USAJOBS account.
To update your application, including supporting documentation, at any time during the announcement open period, return to your USAJOBS account (https://my.usajobs.gov/Account/Login). There you will find a record of your application, the application status, and an option to Edit My Application. This option will no longer be available once the announcement has closed.
To verify the status of your application both during and after the announcement open period, log into your USAJOBS account: https://my.usajobs.gov/Account/Login. All of your applications will appear on the Welcome page. The application record in your USAJOBS account contains a Track This Application link that provides information regarding the documentation you submitted and any correspondence we have sent related to this application, including the invitation to take the USA Hire assessment. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.
Commissioned Corps Officers (including Commissioned Corps professionally boarded applicants) who are interested in applying for this position must send their cover letter and professional resume (not PHS Curriculum Vitae) to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The resume should specifically explain how you are qualified for this position and draw specific attention to your skills and experiences that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. Please send all documents in 1 PDF file. In the subject line of your e-mail include only the Job Announcement Number. In the body of your e-mail include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.
Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.
When the Department of Health and Human Services (HHS) completes its selections, the remaining list of qualified candidates may be shared with other federal agencies. You will have an opportunity to opt in if you would like your name, application material, and assessment results shared for consideration of employment with additional agencies. There is no guarantee of further consideration, and you can continue to explore other job opportunity announcements.
Center for Medicare and Medicaid Innovation
7500 Security Blvd
Woodlawn, MD 21244
US
Next steps
Based on your application and your responses to the application questionnaire, you may be presented with instructions on how to access the USA Hire system to complete the online assessments. The online assessments must be completed within 48 hours following the close of this announcement. You will have the opportunity to request a testing accommodation for the assessment should you have a disability covered under the Americans with Disabilities Act (ADA).
Your assessment results will be kept on record for one year and used toward future positions for which you might apply that require the same assessments.
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
To apply for this position, you must submit a complete Application Package which includes:
1. Resume showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates. For work in the Federal service, you must include the series and grade level for the position(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/.
Your resume will be used to validate your responses to the assessment tool(s). We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Determining length of general or specialized experience is dependent on the information provided in the resume. Failure to include ALL of the information listed below on your resume WILL result in a finding of ineligible.
Official Position Title (include series and grade if Federal job)
Duties (be specific in describing your duties)
Employer's name and address
Supervisor name and phone number
Start and end dates in the month and year format (e.g. June 2007 to April 2008)
Full-time or part-time status (include hours worked per week)
Salary
2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.
3. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments, if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable_Accommodations_for_USA_Hire
Please read the entire announcement and all the instructions before you begin an application. To apply for this position, you must complete the initial online application, to include the initial online assessment and submission of the required documentation specified in the Required Documents section. The complete application package must be submitted by 11:59 PM (ET) on 07/05/2024 of the announcement to receive consideration. The application process is as follows:
To begin the application process, click the Apply button. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
Follow the system prompts in USAJOBS to select your resume and supporting documents; review your application package; include personal information; and continue the application process in the USA Staffing agency site.
Answer the questions presented in the online application and attach all necessary supporting documentation in USA Staffing.
Click the Submit Application button prior to 11:59PM (ET) on 07/05/2024.
After submitting an online application, you will be notified whether or not you are required to take additional online assessments through the USA Hire Competency Based Assessment system. This message will be delivered to you via email notification. The email may be routed to your "Spam" or "Junk" folder.
If you are asked to take the USA Hire Competency Based Assessments, you will be presented with a unique URL to access the USA Hire system. Access to USA Hire is granted through your USAJOBS login credentials. Be sure to review all instructions prior to beginning your USA Hire Assessments. Click here for Computer System Requirements.
Note, set aside at least 3 hours to take these assessments; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue at a later time, you can re-use the URL sent to you via email and also found by clicking the Track This Application link located in the application record in your USAJOBS account.
To update your application, including supporting documentation, at any time during the announcement open period, return to your USAJOBS account (https://my.usajobs.gov/Account/Login). There you will find a record of your application, the application status, and an option to Edit My Application. This option will no longer be available once the announcement has closed.
To verify the status of your application both during and after the announcement open period, log into your USAJOBS account: https://my.usajobs.gov/Account/Login. All of your applications will appear on the Welcome page. The application record in your USAJOBS account contains a Track This Application link that provides information regarding the documentation you submitted and any correspondence we have sent related to this application, including the invitation to take the USA Hire assessment. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.
Commissioned Corps Officers (including Commissioned Corps professionally boarded applicants) who are interested in applying for this position must send their cover letter and professional resume (not PHS Curriculum Vitae) to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The resume should specifically explain how you are qualified for this position and draw specific attention to your skills and experiences that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. Please send all documents in 1 PDF file. In the subject line of your e-mail include only the Job Announcement Number. In the body of your e-mail include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.
Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.
When the Department of Health and Human Services (HHS) completes its selections, the remaining list of qualified candidates may be shared with other federal agencies. You will have an opportunity to opt in if you would like your name, application material, and assessment results shared for consideration of employment with additional agencies. There is no guarantee of further consideration, and you can continue to explore other job opportunity announcements.
Center for Medicare and Medicaid Innovation
7500 Security Blvd
Woodlawn, MD 21244
US
Next steps
Based on your application and your responses to the application questionnaire, you may be presented with instructions on how to access the USA Hire system to complete the online assessments. The online assessments must be completed within 48 hours following the close of this announcement. You will have the opportunity to request a testing accommodation for the assessment should you have a disability covered under the Americans with Disabilities Act (ADA).
Your assessment results will be kept on record for one year and used toward future positions for which you might apply that require the same assessments.
Fair and transparent
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
