The Veterans Affairs (VA) Community Care Operations (CCO) primary mission is to efficiently administer health benefits for Veterans and family members. The Legal Administrative Specialist position is located in Claims Adjudication and Reimbursement Directorate, VA Community Care Operations, and reports to the Supervisor, Appeals Section in Denver, Colorado.

Duties

This position involves a multi-grade career ladder. The major duties listed below represent the full performance level of GS-9. At the GS-7 grade level, you will perform assignments of a more limited scope and with less independence. You will progressively acquire the background necessary to perform at the full performance level of GS-9. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher- level work, and availability of funds. Major Duties and Responsibilities: The employee reviews appeals related to the following Community Care Operations (CCO) programs: Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) Foreign Medical Program (FMP) Spina Bifida (SB) Health Benefits Program VA Health Care Benefits for Children of Women Vietnam Veterans (CWVV) Camp Lejeune Family Members (CLFM) Program Provides technical advice both verbally and in writing to CCO staff on a broad range of appealable issues to include beneficiary eligibility, benefit coverage, mental health, medical determinations, pre-authorization, denial payment issues, reimbursement, and timely filing. Conducts thorough research, problem-solving analysis, and interpretation and evaluation of laws, regulations, and policies associated with CCO-administered programs with the assistance of the Appeal Lead or Supervisor. Makes appeal determinations, supported by facts and a clear understanding of background information. Maintains a data base of appeal decisions. Identifies and recommends, with supporting documentation, necessary changes and process improvements within the employee's area of responsibility. Performs other duties assigned. Work Schedule: Monday through Friday; 8:00 a.m.- 4:00 p.m. Recruitment & Relocation Incentives: Not authorized Telework: Available Upon Supervisory Approval 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. Financial Disclosure Report: Not Required

Requirements

Qualifications

For GS-7: Superior Academic Achievement at the GS-7 level:(SAA) at the baccalaureate level in the coursework detailed above 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: Rank in the upper one-third of your class in the college, university or major subdivision. 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. 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. 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. For more information regarding SAA please visit http://www.opm.gov/qualifications/SEC-II/s2-e5.asp#e4f. - OR- Possess at least one full year of graduate level study, or possess a master's or higher degree etc. in a field that provided the knowledge, skills, and abilities necessary to do the work of this position. (TRANSCRIPTS REQUIRED) -OR- Possess at least one year of work experience Specialized experience is experience that included: Specialized experience is experience that included: utilizing various software programs and maintaining a data base for appropriate and sufficient information for appeal decisions to accomplish administrative duties; ensuring timely and appropriate measures are taken throughout data collection, and data entry process; and preparing, composing, and reviewing correspondence for the purpose of obtaining or supplying information to internal and external customers. equivalent to GS-5 grade level. -OR- Possess an equivalent combination of graduate education and experience to meet the total experience requirements for the GS-7 grade level. NOTE: To calculate the combination of education and experience, determine the amount of experience you have as a percentage for the grade level. Then determine the amount of graduate education you have as a percentage for the grade level. Add the two percentages; the total percentage must equal at least 100% to qualify for the grade level. (TRANSCRIPTS REQUIRED) You will be rated on the following Competencies as part of the assessment questionnaire for this position: Educational Experience (ACWA)Mathematical Skills (ACWA)Rating (ACWA)Social Organizations (ACWA)Work Experience (ACWA) IMPORTANT: A full year of work is considered to be 35-40 hours of work per week. All experience listed on your resume must include the month and year start/end dates. 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. 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; religious; 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. Physical Requirements: The work is primarily sedentary, although some walking, stooping, bending, reaching, and carrying loads weighing up to ten (10) pounds is required. Data entry using a keyboard is required. Work is performed in an office setting. 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

IMPORTANT: 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 Workforce Management - Community Care 120 SE 6th Street Suite 102 Topeka, KS 66603 US
• Name: VHA National Recruitment Center
• Phone: (844)456-5208
• Email: [email protected]