The Legal Administrative Specialist (Appeals Specialist) serves on matters pertaining to the development, evaluation, and disposition of appealed issues for administered programs. Additionally, the Legal Administrative Specialist (Appeals Specialist) provides support to assist Veterans in the reconsideration and appeal process for denied health care claims of medical benefits.

Duties

In this position, you will serve as Legal Administrative Specialist. Typical work assignments include: Reviews claims for error, fact or law. Develop cases based on the submission of additional factual or medical documentation. Responsible for basic and moderately complex research, problem-solving analysis, interpretation and evaluation of laws, regulations, and policies. Documents reconsideration and administrative appeal decisions in designated data bases. Inputs appropriate and sufficient information into the appeals data base. Documents all contacts with providers keeping appellant apprised of appeal status. Determines the specific information needed in support of the Veterans' formal appeal Reviews appeals related to Non-VA Medical Care and Emerging OCC programs such as the Veterans Choice Act. Work Schedule: Monday - Friday (8:00am - 4:30pm); Tour of duty will be determined based on organizational needs. Compressed/Flexible: As determined by the Agency Policy Telework: Yes, after completion of Training Virtual: This is not a virtual position. Position Description/PD#: Legal Administrative Specialist/#35850A/33610A Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required

Requirements

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 07/27/2023. Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-07 position you must have served 52 weeks at the GS-05. For a GS-09 position you must have served 52 weeks at the GS-07. The grade may have been in any occupation but must have been held in the Federal service. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment. Note: Time-In-Grade requirements also apply to former displaced VA Employee's applying under CATP eligibility. You may qualify based on your experience and/or education as described below: GS-07 Specialized Experience: At least one (1) full year of specialized experience, which equips you with the particular knowledge, skills, and abilities to perform successfully the duties of the Legal Administrative Specialist, GS-07 position, and that is typically in or related to the work of the position to be filled. To be creditable, this specialized experience must have been equivalent to the grade GS-05 level in Federal service to qualify at the grade GS-07. Examples of specialized experience include: 1) Analyzing all documentation and verifying its authenticity, as well as whether the documentation meets legal requirements to be accepted as evidence. 2) Experience operating computer application software such as legacy systems, VistA application software, or other electronic health records to include operation of peripheral devices and basic maintenance of the equipment. 3) Experience ensuring timely and appropriate measures are taken throughout data collection, and data entry process. 4) Able to communicates with management in regard to escalated problems and feedback on process improvements. 5) Able to prepare, compose, and review correspondence for the purpose of obtaining or supplying information to internal as well as external customers. OR Substitution of Education for Experience: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have 1 full year of graduate level education or Superior Academic Achievement (SAA)* at the baccalaureate level. *Superior Academic Achievement at the GS-7 level: SAA at the baccalaureate level in the coursework detailed below is fully qualifying. Applicants who wish to apply under this provision must submit proof from their educational institution that they meet one of the criteria listed below. To qualify for SAA, applicants must have completed all the requirements for a bachelor's degree in a curriculum that is qualifying for the position to be filled and meet one of the following: 1. Rank in the upper one-third of your class in the college, university or major subdivision. 2. A grade-point average of "B" (a GPA of 2.95 or higher out of a possible 4.0) for all completed undergraduate courses, or those completed in the last two years of undergraduate study. 3. A grade point average of "B+" (a GPA of 3.45 or higher out of a possible 4.0) for all courses in your major field of study, or those courses in your major completed in the last two years of undergraduate study. 4. Membership in a national honor society (other than freshman honor societies) recognized by the Association of College Honor Societies. For a list of recognized honor societies please visit http://www.achsnatl.org/quick_link.asp; http://www.achsnatl.org/quick_link.asp. OR Combination of Education and Experience: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education beyond 1 semester of graduate level education. GS-09 Specialized Experience: At least one (1) full year of specialized experience, which equips you with the particular knowledge, skills, and abilities to perform successfully the duties of the Legal Administrative Specialist, GS-09 position, and that is typically in or related to the work of the position to be filled. To be creditable, this specialized experience must have been equivalent to the grade GS-07 level in Federal service to qualify at the grade GS-09. Examples of specialized experience include: 1) Knowledge of financial and accounting systems, and regulations to research and process various claims across multiple purchase care programs. 2) Research, interpret and apply data processing codes to various areas of the processing and payment system and interpret computer printouts and detects errors in initial input. 3) Evaluate the relevancy of the sources, appropriately analyzes, and summarizes substantive information. 4) Experience writing in a clear, concise manner, with ability to adequately explain moderately complex matters and describe reasoning and research used in arriving at decisions. 5) Knowledge of claims processing operations, coordination of benefits, medical care cost recovery activities, and fraud, waste, and abuse. OR Substitution of Education for Experience (TRANSCRIPTS REQUIRED): Do you possess a master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related. Such education must demonstrate the knowledge, skills, and abilities necessary to do the work. OR Combination of Education and Experience (TRANSCRIPTS REQUIRED): Do you possess Equivalent combinations of successfully completed graduate education and specialized experience directly related to the work of the Legal Administrative Specialist position, may be substituted to meet the experience requirements for GS-09 position. For example, an applicant with 6 months of appropriate specialized experience equivalent to GS-07 (50 percent of the experience requirement for GS-09) and 1 year of successfully completed graduate education (18 semester hours), as is describe above, (50 percent of the education requirement for the GS-09) would qualify for a GS-09 position. You will be rated on the following Competencies for this position: Problem Solving Technical Competence Analytical Thinking Communication Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Note: A full year of work is considered to be 35-40 hours of work per week. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. Physical Requirements: : Long periods of sitting in one location are required in completing transactions utilizing a computer with standard office equipment. 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/.

Education

A transcript must be submitted with your application if you are basing all or part of your qualifications on education.

Submit a copy of your college transcript (unofficial is acceptable) or you may submit a list with all of your courses, grades, semester, year, and credit for the courses.

Foreign Education: Education completed in foreign colleges or universities may be used to meet Federal qualification requirements if you can show that your foreign education is comparable to education received in accredited educational institutions in the United States. For example, specific courses accepted for college-level credit by an accredited U.S. college or university, or foreign education evaluated by an organization recognized for accreditation by the Department of Education as education equivalent to that gained in an accredited U.S. college or university. It is your responsibility to provide such evidence with your application. See Recognition of Foreign Qualifications for more information.


Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

Contacts

• Address VHA Servicing Human Resources Office - 2 2402 Wildwood Ave Suite 301 Sherwood, AR 72120 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]