Apply on Employer Site

Centers for Medicare & Medicaid Services · 5 hours ago

Health Insurance Specialist (Claims Processing and Systems)

Woodlawn, MD

Full-time

Onsite

Mid, Senior Level

$122K/yr - $158K/yr

1+ years exp

Centers for Medicare & Medicaid Services is a government agency within the Department of Health & Human Services. They are seeking a Health Insurance Specialist (Claims Processing and Systems) to perform claims processing and systems work related to national health insurance programs, including Medicare and Medicaid.

AssociationHealth CareInsuranceMedicalWellness

Growth Opportunities

No H1B

U.S. Citizen Only

Hiring Manager

Heather Campbell

Responsibilities

Serve as an expert in the development, evaluation, and implementation of policies related to claims processing and systems work and may serve as an ad hoc team/project leader

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

Evaluate and analyze the impact of new of revised changes to legislation before the Congress pertaining to any CMS program

Develop, implement, and maintain operational requirements, including standard operating procedures, as well as databases to manage and analyze programmatic information such as routine and ad hoc report, deliverables, and programmatic documentation

Develop, review, and issue specifications, requirements, procedures, and instructional material to process claims from suppliers/providers/insurers

Qualification

Claims processingHealth insurance programsPolicy developmentRequirements developmentAnalytical skillsTeam leadership

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

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:

Evaluating claims processing activities or systems related to national health insurance programs to make recommendations for improvements

Developing requirements to process claims from suppliers/providers/insurers; AND

Planning the implementation of claims processing policy or related systems