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Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare, (CM), Medicare Drug Rebate and Negotiations Group (MDRNG). As a Health Insurance Specialist, GS-0107-12, you will develop, evaluate and implement compliance, audit and oversight requirements, policies, operating procedures related to activities and processes involved with the monitoring and oversight of external CMS stakeholders. Responsibilities Develop, implement, and maintain a comprehensive program oversight strategy and processes for overseeing entities that provide health care and prescription drug services. Develop or revise materials and tools to assess participating entities compliance with requirements of Agency programs. Monitor entities processes to identify program vulnerabilities and ensure that continuing compliance with Agency agreements/contracts and all statutory, regulatory and sub-regulatory requirements are met. Develop, evaluate, and refine regulations, manuals, program guidelines, program memoranda, policy letters and instructions to disseminate and effectively communicate policy to Agency internal and external stakeholders. Requirements Conditions of Employment 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-12, 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-11 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Maintaining oversight processes of major Medicare healthcare programs, including the Medicare Drug Price Negotiation and Inflation Rebate Programs, and/or prescription drug service providers, including manufacturers and dispensing entities; 2) Monitoring Medicare Drug Price Negotiation and Inflation Rebate Program entities and operational stakeholders, including contractors for compliance with requirements and health insurance program regulations and policies; and 3) Conducting reviews to assess program operations for major Medicare healthcare and health insurance programs, including the Medicare Drug Price Negotiation and Inflation Rebate Programs. Substitution of Education for Experience: There is no substitution of education to meet the specialized experience requirement at the GS-12 grade level. Combination of Experience and Education: There is no combination of experience and education to meet the specialized experience requirement at the GS-12 grade level. 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 Federal employees 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/12809844 Education Additional Information Bargaining Unit Position: Yes-American Federation of Government Employees, Local 1923 Tour of Duty: Flexible Recruitment Incentive: Not Authorized Relocation Incentive: Not Authorized Financial Disclosure: Not Authorized Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement. CMS offers flexible working arrangements and allows employees the opportunity to participate in alternative work schedules at the manager's discretion. 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.