The position is located in the Veterans Health Administration (VHA) Office of Finance's, Payment Operations, Internal Controls and Appeals. The VHA Office of Finance mission includes efficiently administering health care benefits for enrolled Veterans receiving medical care and services through the Non-VA Medical Health Care program (previously known as Fee Basis Care).

Duties

Reviews appeals of to the following Non-VA Medical Care programs Non-VA Medical Care program. The Legal Administrative Specialist provides technical advice both verbally and in writing to VHA Office of Finance staff on a broad range of formal administrative appeal issues that include: eligibility, benefit coverage, emergency care, appeals of denied medical care and services, denial of payment, and timely filing of claims. Responsible for basic and moderately complex research, problem-solving analysis, and interpretation and evaluation of laws, regulations, and policies associated with Veteran programs supported by VHA. When applicable, determines the specific information needed in support of the Veterans' formal appeal and in conjunction with applicable guidance and resources to formulate a comprehensive approach to obtain information from field sites to analyze data, facts, and references. Supports VAMC's, contracted staff, and Regional Managers developing accurate, well-documented, complete, and concise determinations clearly outlining further appeal rights to Veterans. Promotion Potential: The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met. Selection at a lower grade level does not guarantee promotion to the full performance level. Work Schedule: Monday - Friday; 40 hours pr week; Tour of duty to be set based on organizational need. Telework: VA supports the use of telework as a way to help attract and retain talented individuals in public service, increase worker productivity, and better prepare the agency to operate during emergencies. This position may be authorized for telework. Telework eligibility will be discussed during the interview process. Virtual: This is not a virtual position. Position Description/PD#: Legal Administrative Specialist/PD33610A and PD035850A Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized Financial Disclosure Report: Not required **Applicants must live within 50 miles of one of the following locations: Vancouver, WA; Helena, MT; St. Louis, MO; Cleveland, OH; Pearl, MS and will be required to report to one of these stations 1-2 times per pay period**

Requirements

Qualifications

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. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. 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. You may qualify based on your experience and/or education as described below: GS -07 Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-05 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: 1) Reviews claims for error, fact or law. 2) Develop cases based on the submission of additional factual or medical documentation. 3) Documents reconsideration and administrative appeal decisions in designated data bases. OR, Education: 1 full year of graduate level education related to the position or superior academic achievement. GS -09 Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-07 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: 1) Responsible for basic and moderately complex research, problem-solving analysis, interpretation and evaluation of laws, regulations, and policies. 2) Reviews appeals related to Non-VA Medical Care and Emerging OCC programs such as the Veterans Choice Act. 3) Documents reconsideration and administrative appeal decisions in designated data bases. 4) Documents all contacts with providers keeping appellant apprised of appeal status. 5) Determines the specific information needed in support of the Veterans' formal appeal OR GS-09: Substitution of Education for Experience (TRANSCRIPTS REQUIRED): You must 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 GS-09: Combination of Education and Experience (TRANSCRIPTS REQUIRED): You must possess Equivalent combinations of successfully completed graduate education and specialized experience You will be rated on the following Competencies for this position: Analytical ThinkingCommunicationsProblem SolvingTechnical Competence 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.

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: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

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]