Health Insurance Specialist (Maryland)

This is a senior policy position (GS 14) at the Department of Health and Human Services.

Job responsibilities include:

• Provide Medicare claims appeals operational guidance and develop solutions to resolve complex programmatic and/or operational issues to peers and contractors on acquisitions, budget, and programmatic issues.

• Lead activities that provide operational guidance to Medicare claim appeals adjudicators, such as Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs),and improve relations with our partners.

• Operate as the senior advisor for Contracting Officer’s Representatives (CORs) and provides guidance on contract oversight, such as statement of work modifications, technical direction, contractor evaluation, and budgeting.

• Prepare program operations budget, manage the acquisition schedule, and track spending.

• Represent CMS in conferences and technical discussions with professional, public, and private organizations, to further the understanding of critical issues, present to the agency’s position.

Experience/Education:

• Negotiating or collaborating with staff to provide guidance on applying contract administration principles to Medicare claim appeals contract oversight work;

• Developing budget projections, requests, or presentations related to budget and financial issues regarding the Medicare claim appeals process; AND

• Interpreting or applying Medicare claim appeals laws, regulations, policies, standards, or procedures to address acquisition issues or explain processes, orally or in writing, to the appropriate audience.

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