USAJOBS · 6 hours ago
Health Insurance Specialist (Technical Advisor)
Woodlawn, Maryland, USA
Full-time
Onsite
Mid, Senior Level
$144K/yr - $144K/yr
1+ years expUSAJOBS is part of the Department of Health & Human Services (HHS) and is seeking a Health Insurance Specialist (Technical Advisor). In this role, you will serve as a technical authority and program expert, leading studies on Medicare operational policy and resolving technical claims processing issues.
ConsultingGovernmentHuman ResourcesInformation TechnologyInternetStaffing Agency
No H1B
U.S. Citizen Only
Responsibilities
Function as the principal original Medicare institutional technical specialist for inpatient hospital claims leading cross-functional from the same or other components
Lead studies that analyze the efficiency, effectiveness, and/or improvement of Medicare operational policy and program operations that impact services provided by contractors and/or providers to beneficiaries
Represent the Division, Group, and Center in resolving technical claims processing issues involving original Medicare institutional claims processing requirements, policy, common working file and standard systems capabilities and program objectives
Evaluate proposed legislation, policy suggestions, or proposals for innovative delivery models for impact on Medicare FFS claims systems and institutional providers
Translate legislative language (e.g., statutory text, conference report information) into specific program goals, actions, and business rules to direct contractor staff in order to reflect statutory changes in MAC claims processing
Qualification
Required
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
You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-13 grade level in the Federal government, obtained in either the private or public sector, to include: 1. Analyzing Medicare institutional claims policies and implement them in Fiscal Intermediary Shared System (FISS); 2. Interpreting Medicare claims processing issues impacting FISS and provide solutions to leadership; AND 3. Leading claims processing projects and provide technical guidance to team members
Your resume (limited to no more than 2 pages) must include detailed information as it relates to the responsibilities and specialized experience for this position
Benefits
A career with the U.S. government provides employees with a comprehensive benefits package.
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent.
Company
USAJOBS
USAJOBS enables federal job seekers to access job opportunities across hundreds of federal agencies and organizations.
10001+ employees
Funding
Current Stage
Late StageRecent News
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