Document 6526253

BHRC POSITION DESCRIPTION COVER SHEET
2. Reason for Submission
3. Service
11. PD Number R90680
5. Duty Station
4. Employing Office
Location
-Reorganization
Ldescription
-
New
X Central
Office
-Washington, D.C.
-Baltimore, MD
Baltimore, MD
Jate Supervisory Certification
-Other
-Regional Office
-X-Other
Location
SF, CA
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1
I
6. Bargaining Unit Status
A 1 0 4 2 Covered Position
8888 Not Covered
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10. Position Sensitivity
I
8. Financial Statement Required
11. Position Status
-
-X- No
-Yes
1
12. Position Indicator
X-Competitive
-Excepted
-SES (Gen)
-SES (CR)
- 3- Top Secret
- 5- MBI
- 5- LBI
6- Public Trust
- 8- SAC
9. Subject to 1A
(To be filled out by CMS's Ethics
Coordinator)
-SF-278
-SF-450
-NO
Nonexempt
X Exempt
-
- 1- NACDJACI
- 2- Secret
I
7. Fair Labor Standards Act
13. Competitive Level Code
-Work Leader (6)
- Supervisor (2)
-X-
Non-Supervisor (8)
14. Administrative Code
FAVC
16. Organizational Title of Position (if different from official title)
17. Number of Allocations for the Position
18. Department
c. Third Subdivision: Office of the San Francisco Regional
Administrator
Health and Human Services
d. Fourth Subdivision:
st Subdivision Center for Medicare and Medicaid Services
b c o n d Subdivision
Consortium for Financial Management and Fee
for Service Operations
e. Fifth Subdivision:
I
19. Supervisory Certification. I certify that this is an accurate statement of the major duties and responsibilities of this position and its organizational relationships,
and that the position is necessary to cany Government functions for which 1 am responsible. This certification is made with the knowledge that this information
is to be used for statutory purposes relating to appointment and payment of public funds, and that false or misleading statements may constitute violations of
such statutes or their implementing regulations.
1
b. Typed Name & Title of Higher-Level Supervisor or Manager (Optional)
a. Typed Name & Title of Immediate Supervisor
David Sayen
Regional Administrator, San Francisco
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Signature
I
I
I
Signature
Date
Date
,i\Slzog
20. Classification/Job Grading ~zrtification.I certify that this position has been classifiedlgraded as required by Title 5,U.S. Code, in conformance with
standards published by the U.S. Office of Personnel Management or, if not published standards apply directly, consistently with the most applicable
published standards.
1
Typed Name and Title of Official Taking Action
21. Pos. Class. Stan. Used In ClassihjingiOrading Position
OPM PCS GS-107 Series
OPM AAGEG
Human Resources Specialist
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22. Remarks
BUC: 1042
1 //F/
1
Information for Employees. The standards, & information on their
application, are available in the personnel office. The classification of the
position may be reviewed & corrected by the agency or OPM. Information on
classification appeals, & complaints on exemption from FLSA, is available
from the personnel office or OPM.
/om ~
\
YCFA'POSITION DESCRIPTION COVER SHEET
3. Service
son f o r S h i s s i o n
'-3mtio
-Central
description R e o r g a n i zat ion-New
:es Management Analyst, (38-343-13 PD#
Office
-1042 Covered Position
Office
Other
8. Financial Statement Required
9. S h j e c t t o IA
-
(To be f il l e d out by HCFA1s
Ethics Coordinator)
-SF-278SF-450No
&Y
11. Position Status
10. Position S e n s i t i v i t y
I
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7. Fair Labor Standards Act
Exempt
L N o n Exempt
x 8888 Not Covered
-Washington,
D.C.
-Baltimore,
M.D.
B a n Francisco, CA
San Francisco, CA
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6. Bargaining hit Status
12. Position Indicator
2 Supervisor 6
&I GS-13 & below -1C
GS-14 & above 5
HIS13
Work Leader
15.
Classified By
Department, A g m y or
Establishment
5 Special AsstJ-8
C
1
O f f i c i a l T i t l e of Position
HEALTH INSURANCE SPECIALIST
14. Achinistrative Code
Non-Supervisor
Pay PLen
e s No
13. Canpetitive Level Code
Excepted
-5
R90680
5. Duty Station
4. Enploying O f f i c e
Location
&Regional
Update Supervisory C e r t i f i c a t i o n
1. PD umber
H L -
Series
Grade
Initials
Date
107
GS
I
16. Organizational T i t l e of Position ( i f d i f f e r e n t from
official title)
17.
18. Department
c.
N u b r of ~ l l o c a t i - n p
2 allocations
+ha D-itim
I
a.
-
.
eeL
Third S d i v i s i o n
Department of Health & Hunan Services
O f f i c e of the Regional A h i n i s t r a t o r
First S d i v i s i o n
d.
Fourth S d i v i s i o n
e.
Fifth S d i v i s i o n
.balth Care Financing A h i n i s t r a t i o n ,
cond S d i v i s i o n
k e s t e r n Consortiun, Region I X
19. Surervisory Certification. I c e r t i f y that t h i s i s an accurate statement of the major duties and r e s w n s i b i l i t i e s of t h i s w s i t i o n
and i t s organizational relationships, a& that the position i s necessary t o carry over-mnt functions f o r which I am responsible. This
c e r t i f i c a t i o n i s mede u i t h the knowledge that t h i s information i s t o be used for statutory purposes r e l a t i n g t o appointment and payment
of p r b l i c fmds, and that false or misleading statements may constitute violations of such statutes or t h e i r implementing regulations.
I
a. Typed Name & T i t l e of Imnediate Supervisor
b. Typed Name & T i t l e of Higher-Level Supervisor or Manager
(Optional)
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Richard Chambers, Acting Deputy Regional A h i n i s t r a t o r ,
HCFA, Region I X
Joe Tilghman, Acting Regional Adninistrator,
HCFA,Region I X
Rd&&&
Signature
Date
that t h i s p o s g i o n has been classified/graded as required% n t l e 5, U.S.
20./~Lassification/Job Greding C e r t i f i c a t i o n . I c&t*y
Code, i n conformance u i t h standards p b l i s h e d by the U.S. Office of Personnel Management or, i f not published standards apply d i r e c t l y ,
consistently with the most applicable published standards.
I
Typed Name and T i t l e of O f f i c i a l Taking Action
21. Position C l a s s i f i c a t i o n Standards Used I n
CLassifying/Grading Position
Chris Havnar
GS-107, d t d 2/1993; AAGEG; 8/1990
Position C l a s s i f i c a t i o n Specialist
7
Informetion f o r Enployees. The standards, & information on
t h e i r application, are available i n the personnel o f f i c e . The
c l a s s i f i c a t i o n of the p o s i t i o n may be reviewed & corrected by
the agency or OPM. Information on c l a s s i f i c a t i o n appeals, &
conplaints on exemption from FLSA, i s available from the
personnel o f f i c e or OPM.
HEALTH INSURANCE SPECIALIST
GS-I 07-13: R90680
INTRODUCTION:
The position is located in the Consortium for Medicare Financial Management and Fee for
Service Operations, San Francisco Regional Office (RO).
Coordinates and executes day-to-day activities that cut across CMS program areas. The
incumbent will also provide reports and other information summarizing and analyzing
activities of the various CMS regional components and develop consolidated RO
responses to inquiries from the various CMS partners, providers, and beneficiaries. 'The
incumbent may plan and implement projects or special events that involve the personal
interaction of the Regional Administrator (RA) andlor the Deputy Regional Administrator
(Dm).
Keeps the RO management team and the Consortium Administrator (CA) apprised of
significant events that impact on the mission and operation of the CMS RO. The
incumbent serves as the media coordinator and FOlA coordinator for the region.
MAJOR DUTIES:
Coordinates day-to-day activities that cut across CMS program areas at the request of the
L, RA andlor DRA, including assisting with the management of workflow and controlled
correspondence to and from the O M . Gathers information from RO components and
synthesizes the results into comprehensive reports. Uses the information gleaned from a
regular scanning of news resources about developments and trends within the health care
marketplace to focus research concerning the impact of those trends on this agency. Uses
that internal and external informationto generate issue papers, decision trees, or strategies
that result in the successful accomplishment of the total mission of the agency.
Provides reports and other information needed by external CMS groups about the extent to
which the activities of the regional CMS components mesh together. Communicates
progress reports on long range projects, initiatives, and action plans via either printed
documents andlor in various electronic formats to the CMS Administrator, Center or Office
Directors, Consortium Administrators, andlor other RAs. Coordinates the submission of
material that is appropriately reported to the White House, the Secretary, and the
Administrator. Serves as the initial RO contact with the Office of Legislation and the Office
of Policy and either prepares or arranges for the preparation of responses to inquiries that
originate from these sources.
Develops consolidated RO responses to inquiries from the various RO partners, providers,
and beneficiaries. Facilitates the development and delivery of responses to inquiries that
originate from individual providers, trade or professional associations, special interest
groups, and public advocacy organizations.
b
Undertakes the planning and implementation of projects or special events that involve the
personal interaction of the RA and/or the DRA. Facilitatesthe interaction of management
staff with the variety of CMS partners and customers. Serves as a personal representative
for the ORA at meetings involving other governmental agencies. Serves as a focal point
for integration of issues and policies having regional or national impact which requires the
immediate attention of the ORA.
Tracks external events that may impact on the CMS mission, objectives and initiatives. By
scanning a variety of news sources, identifies breaking news, investigations, and studies
that w ill have an influence on CMS objectives and operations. Disseminates this
information to the ORA and appropriate components within the RO and Central Office.
(CO)
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Factor 1 Knowledge Required by the Position
Extensive working knowledge of all CMS programs, policies, and operational procedures.
Knowledge of how Titles XVIII, XIX and XXI of the Social Security Act, regulations, and
guidelines interrelate for the implementation of the Medicare and/or Medicaid programs.
b
Knowledge and understanding of the organization, operations, and interrelationships of
State Health Agencies, State Medicaid Agencies, CMS CO, ROs, and government
organizations in general.
Knowledge of the principles, methods, and techniques of program planning and resource
management.
Knowledge of the principles, methods, and techniques of technical program analysis.
Ability to analyze broad and complex operational problems and reach sound conclusions
about them.
Mastery in negotiation and resolution of complex and sensitive issues.
Ability to establish and maintain personal contacts and effective working relationships.
Ability to express and present ideas and conclusions clearly and concisely, both orally and
in writing.
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Factor 2 Supervisory Controls
L
Incumbent works under the general direction of the RA and/or DRA. The incumbent works
with a high degree of independence in the performance of his or her duties with full
responsibility for planning and organizing the details of the work and for selecting methods
and procedures to be used. Work is reviewed in terms of the accomplishment of broad
objectives and priorities.
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Factor 3 Guidelines
Guidelines are basic regulations, general policy statements, and broad objectives of the
federal government, DHHS, CMS, and the RA for improving service to the public through
efficient and economical administration of all program activities.
A high degree of judgement and ingenuity is required in interpreting and applying
guidelines because the incumbent frequently represents the RA and/or DRA in situations
where there is no direct supervision or specific guidance.
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Factor 4 Complexity
L,
Incumbent's projects extend to all CMS regional components and include surveys,
analyses of workload, component performance, and other data. Studies and projects
concern broad and region-wide problems in program administration and interaction
between program and operational components.
Matters studied are program policies and procedures, systems support issues, service to
the public, effectiveness of interaction between regional components, and all other aspects
of RO operations in the region, including the effect of CO decisions or actions in regional
program operations.
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Factor 5 Scope and Effect
The incumbent's work directly contributes to the overall effectiveness of regional program
administration.
The activities, recommendations, and decisions of the incurr~bentmay have a far-ranging
effect on regional office management and regional program administration, and may also
have national implications as well.
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Factor 6 Personal Contacts
Contacts are with executive and specialists at many levels of the federal, state, and local
goverr~mentsand with officials of private and non-government organizations.
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Factor 7 Purpose of Contacts
b
Contacts with the RA and/or DRA focus on keeping them informed of developments.
Contacts with other CMS personnel include providing them with information, resolving
issues and jurisdictional disputes among regional components, and coordinating
interaction. Contacts with outside organizations include discussing sensitive issues as well
as representing CMS programs in general. Contacts will include interaction with various
forms of the media and Congressional offices to discuss sensitive issues.
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Factor 8 Physical Demand
No crnusual effort is required although some travel may be necessary.
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Factor 9 Work Environment
Work is primarily performed in an office setting.
Factor Evaluation System
Position Evaluation Statement
Position #:
Title, Series, Grade:
Organizational location:
R90680
Health Insurance Specialist, GS-107-13
Consortium Administrator for Financial Management and FFS
Operations, San Francisco RO
Level
Comments
1. Knowledge Required
1-8
Requires master of a range of analytical principles and
techniques along with a comprehensive knowledge of
Consortium issues, programs, procedures, and laws.
Knowledge is used to serve as a Special Assistant and
design and conduct studies where the boundaries are broad
and difficult to determine.
2. Supervisory Controls
2-4
Works under general supervision and assignments are
typically self-initiated by the employee. The analyst has
responsibility to plan, design, and carry out proper methods
to use to complete assignments. Completed work is
reviewed for responsiveness and conformance with general
policy.
3. Guidelines
3-5
Policies and guidelines are broadly stated and exist in the
form of agency instructions that are not always applicable.
Judgement must be used in the selection and interpretation
of guidance. Deviation and innovation from traditional
professional methods may be needed by developing new
criteria and methodologies.
650
4. Complexity
4-5
Work consists of policy projects and studies of special
programs learning program effectiveness, efficiency, and
productivity and required the development of detailed plans,
goals, and objectives. Program goals are often conflicting
and the employee must deal with subjective concepts,
uncertain data, and ambiguous program issues.
325
5. Scope and Effect
5-5
The work is designed to provide authoritative analysis that
identifies, interprets, and develops alternatives and options
to complex issues of Medicare fraud and abuse financial
program policy. This may involve developing a range of
approaches and new procedures or regulations.
325
6. Personal Contact
6-3
Contacts are with co-workers, others within the agency, and
in other organizations and with higher ranking officials of
organizations external to the agency.
60
7. Purpose of Contacts
7-4
Contacts are for the purpose of justifying, defending,
negotiating, or settling matters involving significant issues,
and participating in conferences, meetingslpresentations
involving problems of considerable consequence.
220
8. Physical Demands
8-1
Work is sedentary
5
9. Environment
9-1
Work is performed in a typical office setting
5
L"
Total points assigned
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Points
1550
3590
Other Comments:
Grade determined by US OPM Administrative Analysis Grade Evaluation Guide (8190) and US
OPM PCS GS-107 series (02193).
Conclusion:
This position is properly classified as a Health Insurance Specialist, GS-107-13.