Program Specialist

This position is located with the performance management section for the Contracts Management and Performance (CMP) Directorate of Integrated External Networks (IEN).

To meet qualify for this position, all applicants must meet one of the following: SPECIALIZED EXPERIENCE: At least one (1) full year of specialized experience equivalent to at least the next lower grade level (GS-9) in the Federal Service that has given you the particular knowledge, skills and abilities required to successfully perform the duties of this position. Specialized experience includes reviewing and interpreting regulations, policies, and procedures to support program operations and ensure compliance; analyzing data, conducting research, and preparing reports to identify issues, evaluate findings, and support management decision-making; communicating with internal and external stakeholders to provide guidance, resolve issues, and support organizational objectives; monitoring program, project, or contract activities to track performance, validate results, and recommend process improvements; demonstrating knowledge of medical terminology and healthcare reimbursement systems sufficient to support healthcare program operations, claims review activities, and payment processes. NOTE: Applicants wishing to receive credit for such experience must clearly indicate the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. ~OR~ EDUCATION: Successfully completed a Ph.D. or equivalent doctoral degree or 3 full years of progressively higher-level graduate education leading to such a degree in a related field of study that demonstrates your ability to perform the duties of this position. Education must have been obtained from an accredited institution. NOTE: If you select this option, you must submit a copy of your transcript (unofficial or official) with your application. Education cannot be credited without documentation. ~OR~ COMBINATION: Equivalent combinations of successfully completed graduate-level education (beyond the second year) and specialized experience, as described above, which meet the total experience requirements for this grade level. The education portion must have provided the knowledge, skills, and abilities necessary to do the work of this position (as described above). Education must have been obtained from an accredited institution. NOTE: Copies of transcripts must be submitted with your application materials. Education cannot be credited without documentation. ~AND~ SELECTIVE PLACEMENT FACTOR: This position includes a Selective Placement Factor (skill, knowledge, ability or other worker characteristic basic to - and essential for - satisfactory performance of the job). Selective Placement Factors are a prerequisite to appointment and represent minimum requirements for a position. Applicants who do not meet it are ineligible for further consideration. The Selective Placement Factor for this position is: Experience supporting healthcare managed care, payer/provider operations, or health plan administration. This experience must include provider network functions (such as network operations, network adequacy, provider relations, or provider contracting) and at least one additional healthcare operational function, such as provider credentialing or enrollment, claims processing, reimbursement or payment operations, healthcare analytics or reporting, utilization management, clinical quality, appeals and grievances, customer or member services, third-party administrator oversight, or similar payer-focused functions. (This experience must be documented in your resume.) For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.