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 L 1 I 6. Bargaining Unit Status A 1 0 4 2 Covered Position 8888 Not Covered I 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 -* 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 ' 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 I 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 I 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) I 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) - 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. - 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. - 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. - 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. - 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. - 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. - 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. - Factor 8 Physical Demand No crnusual effort is required although some travel may be necessary. - 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 '- 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.