Job posting has expired

Director Provider Billing Group

Centers for Medicare and Medicaid Services
$141,022.00 - $221,900.00 / yr
United States, California, San Francisco
April 11, 2024
Duties Leads and directs the development of the requirements, methods, standards, policies, procedures, and budget guidelines for Medicare FFS claims processing related activities. Provides operational expertise to the development and implementation of Agency policies, regulations, procedures, new payment models and legislative proposals, taking into consideration the impacts on affected stakeholders and business processes. Coordinates modifications to existing operational procedures, contracts, and related materials, as required. Recommends alternatives to existing processes, policies, and procedures, as well as methods of improvement. Identifies and reacts to deficiencies in Medicare FFS claims processing requirements and develops instructions and guidelines for proper claims processing, including findings identified in OIG and GAO reports. Directs the development and release of pricing software and files used in Medicare FFS claims processing for institutional, professional and supplier claims, including Pricers, fee schedules, and coding files. Directs the development of data analysis programs and software modules necessary to support Medicare FFS payment policy development. Requirements Conditions of Employment U.S. Citizenship required. Background and/or Security Investigation required. One year SES probationary period required. The Ethics in Government Act, PL 95-521 requires the applicant selected for this position to submit a financial disclosure statement, SF-278, prior to assuming the SES position, annually, and upon termination of employment. Status applicants must submit a copy of their most recent SF-50, Notification of Personnel Action, which verifies status. All initial appointments to an SES position are contingent on approval from OPM's Qualifications Review Board unless the selectee has successfully participated in an OPM approved SES Candidate Development Program. All male applicants born after December 31, 1959, must have registered for the selective service. You will be required to sign a statement certifying his registration, or the applicant must demonstrate exempt status under the Selective Service Law. Only experience obtained by the closing date of this announcement will be considered. Qualifications All competitive candidates for SES positions with the Federal Government must demonstrate leadership experience indicative of senior executive level management capability. To meet the minimum qualification requirements for this position, you must show in your resume that you possess the Fundamental Competencies, five Executive Core Qualifications, and the Professional/Technical Qualifications listed below. Evidence of this experience must be incorporated into your five page resume. Separate narratives for the Executive Core Qualifications and/or Professional/Technical Qualifications will not be accepted or considered. Typically, experience of this nature is gained at or above the GS-15 grade level in the Federal service, or its equivalent with state or local government, the private sector, or nongovernmental organizations. Fundamental Competencies: Interpersonal Skills, Oral Communication, Integrity/Honesty, Written Communication, Continual Learning, and Public Service Motivation. Executive Core Qualifications (ECQs) Leading Change: The ability to bring about strategic change, both within and outside the organization, to meet organizational goals. Inherent to this ECQ is the ability to establish an organizational vision and to implement it in a continuously changing environment. Leading People: The ability to lead people toward meeting the organization's vision, mission, and goals. Inherent to this ECQ is the ability to provide an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts. Results Driven: The ability to meet organizational goals and customer expectations. Inherent to this ECQ is the ability to make decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks. Business Acumen: The ability to manage human, financial, and information resources strategically. Building Coalitions: The ability to build coalitions internally and with other Federal agencies, State and local governments, nonprofit and private sector organizations, foreign governments, or international organizations to achieve common goals. Professional/Technical Qualifications (PTQs) This position also requires that you possess PTQs that represent knowledge, skills, and abilities essential for success in this role. The following PTQs must be evident in your resume. Demonstrated knowledge and leadership experience related to a large-scale health care program or entity, including the critical operational, policy, and financial forces that influence organizational results. Demonstrated experience, in an executive leadership position, in negotiation and collaboration with a wide range of senior leaders on complex issues concerning a national/state health care program or large-scale health care entity. Demonstrated experience in developing and managing implementation of a strategic plan for a large-scale health care program or entity. It is STRONGLY recommended that you visit the following Office of Personnel Management (OPM) webpage for more information regarding the Fundamental Competencies and ECQs. If selected, you will be required to complete an ECQ package by drafting narratives for each of the ECQs for submission and certification by an OPM Qualifications Review Board (QRB) in order to be placed in this position. If you are currently serving in a career SES appointment, are eligible for reinstatement into the SES, or have successfully completed an SES Candidate Development Program approved by the Office of Personnel Management (OPM), you will not need to draft the ECQs. Education This job does not have an education qualification requirement. Additional information Salary for SES positions varies depending on qualifications. The annual salary range is found at the top of this announcement. The selectee for this position may be eligible for annual performance bonuses and performance-based pay adjustments. Veteran's Preference does not apply to the SES. Workplace Flexibility at CMS: This position has a regular and recurring reporting requirement to the CMS office listed in this announcement; however, CMS offers flexible working arrangements and allows employees the opportunity to participate in telework combined with alternative work schedules at the manager's discretion. This position may be authorized for telework. Telework eligibility will be discussed during the interview process. Supervisory positions must report a minimum 2 times per week and non-Supervisory positions must report a minimum of 2 times per pay period. To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply. 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. . 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. Required Documents All applicants are required to submit and/or complete the following documents to be considered for the position: Resume that contains your full name, address and phone number, and does not exceed the five page limit; Cover Letter (optional); NOTE: THE USAJOBS RESUME TEMPLATE MAY RESULT IN A RESUME BEING LONGER THAN FIVE PAGES. PLEASE VERIFY PAGE LENGTH BEFORE SUBMISSION OF APPLICATION. Applicants who are currently, or were previously, Federal employees must also submit: An SF-50 showing your current or former civil service status; and Proof of OPM Qualifications Review Board certification (OPM-approved SES Candidate Development Program graduates), if applicable. NOTE: Documents submitted that are not listed in the Required Documents section of this announcement will not be considered or forwarded to the rating panel or selecting official. How to Apply The application process used to recruit for this position is the RESUME BASED method. Although applicants cannot address the ECQs or PTQs separately, evidence of each must be clearly demonstrated in the five page resume and throughout the rest of the application package. To be considered for this position, you must submit a complete application no later than 11:59 PM (Eastern Time) on the closing date of the announcement - 04/25/2024. If you fail to submit a complete application prior to the closing time, the application system will not allow you to finish. Requests for extensions will not be granted, so please begin the application process with enough time to finish before the deadline. ALL APPLICANTS (including Commissioned Corps Officers): You must submit a resume (five-page maximum - resumes that exceed the five-page limit will not be considered). You may also submit an optional cover letter. Separate written narratives addressing the ECQs and PTQs will not be considered. You must complete the online assessment questions. If your resume does not support the responses in your questionnaire, you may be rated "ineligible." We recommend that your resume emphasize your level of responsibilities, the scope and complexity of the programs managed, and your program accomplishments, including the results of your actions. Your five page resume should include the following: Job Information (Announcement number and title of job for which you are applying) Personal Information (Full name, mailing address, work and home phone number and email addresses) Education (College/University name, city and state, major, type and year of degree) Work Experience (Job title (including series and grade, if Federal employment, duties and accomplishments, employer's name and address, start and end dates (month and year), hours per week, and salary) Evidence of experience which addresses the five ECQs and the PTQs. Other qualifications (Job-related training courses (title and year), skills, certifications and licenses, honors, awards, and special accomplishments). It is important that your resume be complete and thorough. Please be sure to include and address all ECQs and PTQs in your resume. A sample five-page resume that incorporates the ECQs can be found in OPM's Guide to Senior Executive Service Qualifications: Steps to submit a complete application: You must have a USAJobs account and be logged in. Once you are logged in and all of your application materials are ready, click the "Apply" button. You will then be asked to upload your resume and optional cover letter. Additional documentation not listed in the Required Documents will not be considered. Agency contact information Margaret Moore Phone Email Address Center for Medicare 7500 Security Blvd Woodlawn, MD 21244 US Next steps You will receive an email informing you of the receipt of your application. Applicants who are determined to be highly qualified by the SES rating panel will be referred to the selecting official for further consideration and possible interview, at which time you will be contacted. All applicants will be notified of the outcome of their applications once a final selection is made. Fair & Transparent The Federal hiring process is set up to be fair and transparent. Please read the following guidance.