Provider Contracting Director jobs in San Francisco, CA

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.

How You Will Be Evaluated

• Benefits

  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. Opens in a new windowLearn more about federal benefits.

  Review our benefits

  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

  As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have - whether you're a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you're eligible under their policies.

  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);

  • Online Assessment Questionnaire. To preview the assessment questionnaire, click here: https://apply.usastaffing.gov/ViewQuestionnaire/12379209

  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: https://www.opm.gov/policy-data-oversight/senior-executive-service/reference-materials/guidetosesquals_2012.pdf
  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 must respond to all application assessment questions, carefully following the instructions provided. To preview the questions, click here: https://apply.usastaffing.gov/ViewQuestionnaire/12379209

  • 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

  000-000-0000

  Email

  Margaret.moore@cms.hhs.gov

  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 and Transparent

  The Federal hiring process is set up to be fair and transparent. Please read the following guidance.

  • Equal Employment Opportunity (EEO) Policy
  • Reasonable accommodation policy
  • Financial suitability
  • Selective Service
  • New employee probationary period
  • Signature and false statements
  • Privacy Act
  • Social security number request

Required Documents

Clarification from the agency

All groups of qualified individuals