Job details

Salary
$49,157 - $78,167 a year
Job Type
Full-time

Full Job Description

Duties

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI) Front Office.

As a Health Insurance Specialist (Program Integrity), GS-0107-7/9, you will be responsible for executing a wide range of program integrity initiatives that support CMS' lines of business through program integrity reviews.


Responsibilities

  • Assist in researching and analyzing financial program payment data and identify significant sources of information.
  • Research, interpret, and apply Federal statute and other program integrity guidance to identify and provide suggestions for resolving basic program issues.
  • Provide routine technical information to stakeholders (e.g., Medicare, Medicaid, and/or private insurance that provide health care and drug services, and Providers), on CMS requirements.
  • Develop responses to inquiries regarding program integrity to a variety of internal and external stakeholders.

Travel Required

Occasional travel - You may be expected to travel up to 5% for this position.

Supervisory status

No

Promotion Potential

12

  • Job family (Series)

    0107 Health Insurance Administration

  • Requirements

    Requirements

    Conditions of Employment

    • You must be a U.S. Citizen or National to apply for this position.
    • You will be subject to a background and suitability investigation.
    • Time-in-Grade restrictions apply.

    Qualifications

    ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF 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-07, 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-05 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Reviewing health insurance laws, regulations, or policies; (2) Responding to routine inquiries regarding program activities; and (3) Analyzing routine reports to detect basic program issues.
    - OR -
    Have completed one full year of graduate level education or possess superior academic achievement. (TRANSCRIPT REQUIRED AT TIME OF APPLICATION)
    - OR -
    Have a combination of specialized experience as described in "A" above and graduate education as described in "B" above. To combine education and experience, determine the total qualifying experience as a percentage of the experience required for the grade level. Then determine the education as a percentage of the education required for the grade level (note: only graduate education in excess of 2 full years, 36 semester hours or equivalent is creditable). Finally, add two percentages. The total percentage must equal at least 100 percent. (TRANSCRIPT REQUIRED AT TIME OF APPLICATION)

    TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see "Required Documents" section below for what documentation is required at the time of application.

    In order to qualify for the GS-09, 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-07 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Gathering data to support investigations of fraud, waste, or abuse of a health insurance program; (2) collaborating across organizational lines on investigations, audits, or oversight of health insurance programs; and (3) Researching health care statutes or guidance to report basic program issues.
    - OR -
    Possess a Master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., in a related field of study. (TRANSCRIPT REQUIRED AT TIME OF APPLICATION)
    - OR -
    Have a combination of specialized experience as described in "A" above and graduate education as described in "B" above. To combine education and experience, determine the applicant's total qualifying experience as a percentage of the experience required for the grade level. Then determine the applicant's education as a percentage of the education required for the grade level. Finally, add two percentages. The total percentage must equal at least 100 percent. (TRANSCRIPT REQUIRED AT TIME OF APPLICATION)

    TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see "Required Documents" section below for what documentation is required at the time of application.


    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/11065708

    Education

    Additional information

    Bargaining Unit Position: Yes
    Tour of Duty: Flexible
    Recruitment/Relocation Incentive: Not Authorized
    Financial Disclosure: Not Required

    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.

    Additional Forms REQUIRED Prior to Appointment:

    • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation - A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
    • Form I-9, Employment Verification and the Electronic Eligibility Verification Program - CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
    • Standard Form 61, Appointment Affidavits - If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.

    If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

    How You Will Be Evaluated

    You will be evaluated for this job based on how well you meet the qualifications above.

    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 any interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.

    Once the announcement has closed, your online application, resume, transcripts and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.

    Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):

    • Oral Communication
    • Policy Analysis
    • Program Integrity
    • Written Communication

    Background checks and security clearance

    Security clearance

    Not Required

    Drug test required

    No

    Position sensitivity and risk

    Moderate Risk (MR)

    Trust determination process

    Credentialing, Suitability/Fitness

  • Required Documents

    Required Documents

    The following documents are REQUIRED:

    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 (mm/dd/yy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

    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. College Transcripts. Although this position does not require a degree, you may substitute college credit in whole, or in part, for experience at specified grade levels. You must submit a copy of your transcript at the time of application in order to substitute your education for the required experience. If you do not submit a transcript, your education will not be considered in determining your qualifications for the position. You may submit an unofficial transcript or a list of college courses completed indicating course title, credit hours, and grades received. An official transcript is required if you are selected for the position.

    College Transcripts and Foreign Education: Applicants who have completed part or all of their education outside of the U.S. must have their foreign education evaluated by an accredited organization to ensure that the foreign education is comparable to education received in accredited educational institutions in the U.S. For a listing of services that can perform this evaluation, visit the National Association of Credential Evaluation Services website. This list, which may not be all inclusive, is for informational purposes only and does not imply any endorsement of any specific agency.

    PLEASE NOTE: A complete application package includes the online application, resume, transcripts (if qualifying through education substitution or a combination of education and experience) and CMS required documents. Please carefully review the full job announcement to include the "Required Documents" and "How to Apply" sections. Failure to submit the online application, resume, transcripts (if applicable) and CMS required documents, will result in you not being considered for employment.

    If you are relying on your education to meet qualification requirements:

    Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

    Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

  • Benefits

    Benefits

    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.

    Review our 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.


Help

This job is open to

  • Career transition (CTAP, ICTAP, RPL)

    Federal employees who meet the definition of a "surplus" or "displaced" employee.

  • Land & base management

    Certain current or former term or temporary federal employees of a land or base management agency.

  • Veterans

Clarification from the agency

Veterans Employment Opportunity Act (VEOA) Land Management


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