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Medical Policy Specialist jobs in Virginia

Medical Policy Specialist researches and designs criteria to determine policy guidelines used in review of patient cases to ensure only medically appropriate services are reimbursed. Recommends a policy and process that ensure alignment with company guidelines and nationally accepted medical/coding standards. Being a Medical Policy Specialist establishes the proper codes to use for claims processing. Responds to questions from medical staff and communicates details about policy and guidelines. Additionally, Medical Policy Specialist requires a bachelor's degree. Typically reports to a supervisor or manager. Requires Registered Nurse RN. The Medical Policy Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Medical Policy Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

Recently Added Medical Policy Specialist jobs

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FOREIGN AFFAIRS SPECIALIST
  • Office of the Under Secretary of Defense for Policy
  • Arlington, VA PART_TIME
  • Help Help

    Duties

    Incumbent Typical Work Assignments May Include The Following

    • Plays a major role in the study, review, and adjustment of the strategies, concepts, programs, and budgets required to support OSD policy and program guidance; focuses senior policy attention on issues with major defense policy, national security, or international security implications.
    • Takes a lead role in managing team projects, including actively encouraging communication, coordination, innovation, and high quality team products; analyses highly complex policy, strategy, and force posture alternatives and implications.
    • Provides expert advice at the ASD or higher level on key strategy and various other matters; reviews and develops Policy positions and responses to action originating in other DoD and non-DoD offices or agencies that have implications for foreign policy and national security policy, strategy, program, planning, and budgets.
    • Represents DoD in delegations to international meetings and conferences; represents DoD positions during contact with the Congressional staff; monitors Congressional action on DoD defense strategy, programs, and budget; and develops or contributes testimony or other presentations to the Congress.

    Help Help

    Requirements

    Conditions of Employment

    • U.S. Citizenship is required
    • Males born after 12-31-59 must be registered or exempt from Selective Service (see https://www.sss.gov/Home/Registration)
    • Required to participate in the direct deposit program
    • Individuals tentatively selected for drug testing designated positions will be required to submit to urinalysis for illegal drugs prior to appointment and are subjected to random drug testing.
    • This position has been designated as Special Sensitive. The incumbent is required to obtain and maintain a Top Secret security clearance with SCI and SAP components.
    • The incumbent must adhere to DoD Standards of Conduct
    • This position may require occasional travel (up to 20%) away from your normal duty station on military or commercial aircraft.
    • This position may require you to work other than normal hours, which may include evenings, weekends, and/or holidays and/or overtime.
    • Student loan repayment may be authorized in accordance with regulatory requirements.
    • If you are invited for an interview, you will be required to provide a writing sample which will be a timed writing exercise you will turn in at the end of a scheduled session.

    Qualifications

    Basic Requirement:

    Degree: major or equivalent, or a combination of courses totaling at least 24 semester hours, in international law and international relations, political science, economics, history, sociology, geography, social or cultural anthropology, law, statistics, or in the humanities; or 12 semester hours in one of the above disciplines and 12 semester hours in statistics/quantitative methods.

    OR

    Combination of education and experience: courses equivalent to a major, or a combination of related courses totaling at least 24 semester hours, as shown in A above, plus appropriate experience or additional education.

    OR

    Experience: four years of appropriate experience in one or more of the fields listed above in work associated with international organizations, problems, or other aspects of foreign affairs.

    Time In Grade

    For entry at the GS-13 level, status applicants must have served 52 weeks as a GS-12 or higher grade in the Federal Service.

    For entry at the GS-14 level, status applicants must have served 52 weeks as a GS-13 or higher grade in the Federal Service.

    For entry at the GS-15 level, status applicants must have served 52 weeks as a GS-14 or higher grade in the Federal Service.

    Specialized Experience

    For the GS-13, you must have at least one year of specialized experience equivalent in level of difficulty and responsibility to the GS-12 grade level in the Federal service, or comparable in difficulty and responsibility to GS-12 if outside the Federal service.

    Specialized experience is defined as supporting senior U.S. Government civilian leadership on national security matters and strategic level interests related to the Middle East, to include Iran or the Gulf; preparing information papers, memos, briefings, and/or messaging related to the Middle East, Iran, or Gulf for senior U.S. Government civilian leadership engagements and bilateral or multilateral dialogues; coordinating on U.S. Government policy positions with interagency counterparts, such as the National Security Council or State Department; and supporting the preparations of senior U.S. Government civilian leadership for engagements with Congress, think tanks, or the media on Middle East security issues.

    For the GS-14, you must have at least one year of specialized experience equivalent in level of difficulty and responsibility to the GS-13 grade level in the Federal service, or comparable in difficulty and responsibility to GS-13 if outside the Federal service.

    Specialized experience is defined as analyzing and supporting senior U.S. Government civilian leadership on national security matters and strategic-level interests related to the Middle East, to include Iran or the Gulf; preparing information papers, memos, briefings, and/or messaging related to the Middle East, Iran, or Gulf for senior U.S. Government civilian leadership engagements and bilateral or multilateral dialogues; collaborating on U.S. Government policy positions with interagency counterparts, such as the National Security Council or State Department; preparing recommendations and analysis for senior U.S. Government civilian leadership participation in the U.S. National Security Council-led interagency decision making process; and conducting research and analysis to prepare senior U.S. Government civilian leadership for engagements with Congress, think tanks, or the media on Middle East security issues.

    For the GS-15, you must have at least one year of specialized experience equivalent in level of difficulty and responsibility to the GS-14 grade level in the Federal service, or comparable in difficulty and responsibility to GS-14 if outside the Federal service.

    Specialized experience is defined as advising senior U.S. Government civilian leadership on national security matters and strategic-level interests related to the Middle East, to include Iran or the Gulf; reviewing and preparing information papers, memos, briefings, and/or messaging related to the Middle East, Iran, or Gulf for senior U.S. Government civilian leadership engagements and bilateral or multilateral dialogues; collaborating and representing U.S. Government policy priorities with interagency counterparts, such as the National Security Council or State Department; preparing senior U.S. Government civilian leadership for participation in the U.S. National Security Council-led interagency decision making process; and preparing senior U.S. Government civilian leadership for engagements with Congress, think tanks, or the media on Middle East security issues.

    In addition to meeting the specialized experience requirements, qualified applicants must also possess the quality of experience as it relates to how closely or to what extent an applicant's background, recency of experience, education, and training are relevant to the duties and responsibilities of the announced position. Candidates must clearly demonstrate the possession of competencies necessary to successfully perform the work of the position at the appropriate level to be qualified for the position. Applicants must describe how their experience meets the competencies within the body of the resume. No separate statements addressing competencies are required.

    Competencies: International Engagement Action Planning, International Engagement Assessment & Analysis, International Engagement Implementation, International Engagement Policy Development, Oral Communication, and Writing

    Qualification and time-in-grade requirements must be met at the closing date of this announcement.

    Education

    There is no substitution of education for the qualifying experience at the GS-13, 14, or 15 grade levels.

    ARE YOU QUALIFYING BASED ON A COMBINATION OF EDUCATION AND EXPERIENCE?

    You must provide sufficient documentation of your education in your resume. You are strongly encouraged to provide a copy of transcripts or degrees in your application package. It is also acceptable to document your applicable course listing in your resume (course number, credits earned, etc.). Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education. Applicants can verify accreditation at the following website: http://www.ed.gov/admins/finaid/accred/index.html. All education claimed by applicants will be verified by the appointing agency. If selected, an official/sealed transcript will be required prior to appointment.

    To be creditable, education must have been obtained in an accredited college or university. You must report only attendance and/or degrees from schools accredited by accrediting institutions that are recognized by the U.S. Department of Education.

    Foreign Education: If you are using education completed in foreign colleges or universities to meet the qualification requirements, you must show that the education credentials have been evaluated by the National Association of Credential Evaluation Services at the time of application. National Association of Credential Evaluation Services.

    Additional information

    • A one year probationary or trial period may be required.
    • Telework availability will be based upon the mission requirements and supervisory determination
    • Individuals tentatively selected for drug testing designated positions will be required to submit to urinalysis for illegal drugs prior to appointment or placement.
    • Management has the prerogative to select at either grade level.
    • This recruitment provides promotion opportunity to target position without further competition when selectee is eligible and recommended by management. However promotion is not guaranteed and no promise of a promotion is implied.
    • We may use this announcement to fill additional vacancies within 90 days of the closing date.
    • Moving costs will not be paid.
    • Recruitment, relocation, or retention incentives will not be authorized.
    • The Tax Cuts and Jobs Act of 2017 makes certain reimbursements/payments taxable. For information on these changes and the Relocation Income Tax Allowance (RITA), for which some appointees are eligible, click here.
    • Employee is subject to recall or call back during off-shift hours, 7 days a week, 24 hours a day, if required by upper management.
    • For more information on veterans' preference click here.
    • Males born after 12-31-59 must be registered or exempt from Selective Service (to verify your registration status click here).
    • Interagency Career Transition Assistance Program (ICTAP): For information on how to apply as an ICTAP eligible click here. To be well-qualified and exercise selection priority for this vacancy, displaced Federal employees must be rated at 85 or above on the rating criteria for this position.
    • The Department of Defense (DoD) policy on employment of annuitants issued March 18, 2004 will be used in determining eligibility of annuitants.
    • This position is subject to the limitations imposed by the DOD Priority Placement Program.
    • Priority Placement Program (PPP) Military Spouse Preference (MSP) eligible candidates will receive priority consideration at the highest grade level for which they have applied and been determined best qualified up to and including the full performance level.
    • PPP Application Based Preference eligibles (Military Reserve and National Guard technicians, Military Reserve and National Guard technicians receiving disability retirement, and Retained Grade employees) will receive priority consideration at the full performance level only.
    • For more information regarding qualifications requirements please click here.
    • You may submit a cover letter which will be forwarded to the selecting official with your resume. Your cover letter will not be used to verify your qualifications or eligibility
    • All applicants are encouraged to apply electronically. If you are unable to apply on-line, you may contact 317-212-0454 for assistance.

    Read more

    • Help Help 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.

    How You Will Be Evaluated

    You will be evaluated for this job based on how well you meet the qualifications above.

    SME Panel Review

    Human resources will review resumes for eligibility, and then forward eligible resumes to a Subject Matter Expert (SME Panel) for determination of minimum qualifications. Eligible candidates determined to be qualified by the SME Panel will be certified for further consideration.

    Once the application process is complete, a review of your resume and supporting documentation will be made and compared against your responses to the applicant questionnaire to determine if you are qualified for this job. If, after reviewing your resume and or supporting documentation, a determination is made that you have inflated your qualifications and or experience, you may lose consideration for this position. Please follow all instructions carefully. Errors or omissions may affect your rating.

    Education

    The Assessment Questionnaire takes approximately 15 minutes to complete and collects information on your education, training and experience related to the following critical competencies:

    • International Engagement Action Planning
    • International Engagement Assessment & Analysis
    • International Engagement Implementation
    • International Engagement Policy Development
    • Oral Communication
    • Writing

    You can preview the Questionnaire here:https://apply.usastaffing.gov/ViewQuestionnaire/12431570

    Applicants who disqualify themselves will not be evaluated further.

    Help Help

    Required Documents

    FOR THIS JOB ANNOUNCEMENT THE FOLLOWING SUPPORTING DOCUMENTS ARE REQUIRED AS THEY APPLY STATED BELOW AND MUST BE RECEIVED BY THE CLOSE OF THE ANNOUNCEMENT. NOT ALL DOCUMENTS WILL APPLY TO EVERYONE.

    • Transcripts - Official or unofficial transcripts are acceptable. (WHS serviced employees will be verified via eOPF or you may include them in your application package. However, it is the employee's responsibility to ensure that his/her eOPF contains the required transcript and is up-to-date).
    • SF-50 - (if applicable) Notification of Personnel Action for current or former federal employees- All applicants must provide your most recent SF50 or the SF50 reflecting Career/Career-Conditional tenure and the highest grade held on a permanent basis.
    • Most recent SF-50 "Notification of Personnel Action" showing you are/were in the competitive service and the highest grade held. It is recommended you provide a SF-50 within the last 52 weeks before the closing date of this JOA for current federal employees. Effective 5/25/2022, WHS HRD will use the resume in conjunction with the provided SF-50 to confirm Current Federal Employee eligibility. We will complete confirmation of Current Federal Employee eligibility at the job offer phase if needed. It is still required that you submit at least one SF-50 with your application and confirm you are a current federal employee via your employment dates on your resume for current federal employee eligibility determinations. (WHS serviced employees SF-50s can be verified via eOPF).
    • Veterans Preference Documentation (if applicable): Candidates claiming Veterans Preference must submit a DD-214 (Member Copy 4), or, if you are CURRENTLY serving on active duty, a statement of service from your unit which states the date you entered on active duty, the date you are separating, and the campaign medals you have received. For those supplying the statement of service, preference will be verified by a DD-214 (Member Copy 4) upon separation from the military. Veterans with a service-connected disability must also submit a VA letter dated 1991 or later. DoD Components with CES positions apply Veterans' Preference to preference eligible candidates, as defined by Section 2108 of the Title 5 U.S.C. in accordance with the procedures provided in DoD Instruction 1400.25, Volume 3005, "CES Employment and Placement."
    • Military Spouse Preference (MSP) Eligible: Military Spouse Preference applicants, must be selected and placed at the highest grade level for which they have applied and been determined best qualified up to and including the full performance level. You must include a completed copy of the Military Spouse PPP Self-Certification Checklist dated within 30 days along with the documents identified on the checklist to verify your eligibility for Military Spouse Preference. Click here to obtain a copy of the Military Spouse PPP Self-Certification Checklist.
    • Military Reserve (MR) and National Guard (NG) Technicians PPP Eligible: MR and NG technicians PPP applicants must be selected and placed at the full performance level if determined well qualified. You must include a completed copy of the Military Reserve and National Guard Technician PPP Self-Certification Checklist to verify your eligibility for Military Reserve and National Guard Technician preference. Click here to obtain a copy of the Military Reserve and National Guard Technician PPP Self-Certification Checklist.
    • Military Reserve (MR) and National Guard (NG) Technicians Receiving Disability Retirement PPP Eligible: MR and NG technicians receiving disability retirement PPP applicants must be selected and placed at the full performance level if determined well qualified. You must include a completed copy of the Military Reserve and National Guard Technician Disability PPP Self-Certification Checklist to verify your eligibility for Military Reserve and National Guard Technician Disability preference. Click here to obtain a copy of the Military Reserve and National Guard Technician Disability PPP Self-Certification Checklist.
    • Retained Grade PPP Eligible: Retained Grade PPP applicants, must be selected and placed at the full performance level if determined well qualified. You must include a completed copy of the Retained Grade PPP Self-Certification Checklist to verify your eligibility for Retained Grade preference. Click here to obtain a copy of the Retained Grade PPP Self-Certification Checklist.

    Your complete Application Package (containing the above required documents) must be received no later than 11:59 pm Eastern Time on 06/12/2024.

    HR will not modify answers submitted by an applicant.
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IT Specialist (PLCYPLN)
  • Office of the Under Secretary of Defense for Policy
  • Arlington, VA PART_TIME
  • Help HelpDutiesIncumbent Typical Work Assignments May Include The FollowingActs as principal technical advisor and action lead for the development and execution oversight of DoD-wide plans and policie...
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About Virginia

Virginia (/vərˈdʒɪniə/ (listen)), officially the Commonwealth of Virginia, is a state in the Southeastern and Mid-Atlantic regions of the United States located between the Atlantic Coast and the Appalachian Mountains. Virginia is nicknamed the "Old Dominion" due to its status as the first English colonial possession established in mainland North America and "Mother of Presidents" because eight U.S. presidents were born there, more than any other state. The geography and climate of the Commonwealth are shaped by the Blue Ridge Mountains and the Chesapeake Bay, which provide habitat for much of ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Policy Specialist jobs
$90,131 to $110,014

Most Popular Cities in Virginia for Medical Policy Specialist Jobs

What does a Medical Policy Specialist do?

Medical Policy Specialist in Norfolk, VA
Guideline 9 – specialist medical procedures provides that applications for the separate representation of children with an intellectual impairment in relation to applications for special medical procedures are not subject to the means test or merits test.
February 20, 2020