This position is located in the Appeals Directorate, Veteran Health Administration (VHA) Integrated Veteran Care (IVC). The incumbent serves as Lead, Appeals Specialists on matters pertaining to the development, evaluation, and disposition of appealed issues for the IVC Appeals Directorate administered programs.

Duties

Duties include, but not be limited to: Provides technical assistance and advice to LAS and other staff members both verbally, and in writing on issues related to beneficiary eligibility, benefit coverage, reimbursement, claims processing, and program administration. Develops responses to correspondence from other Federal agencies, providers, professional organizations, and Congressional offices. Consults with the Program Management Office when appropriate, on complex policy issues, interpretations, and payment issues. Consults with Program Integrity on various code edits applied to deter and identify potential fraud and abuse. Responsible for research, problem-solving analysis, interpretation and evaluation of laws, regulations, and policies associated with IVC-administered programs. Conducts thorough research of issues to aid our beneficiaries per law. Determines the specific information needed and formulates a comprehensive approach to obtain and analyze data, facts, and references. Provides accurate, well-documented, concise determinations to our beneficiaries. Consults with staff regarding clinical appropriateness as well as statute, regulatory issues, and policy interpretations. Consultations may also include working with payment and program integrity specialists to determine current system outcomes. Work Schedule: Monday - Friday, 7:30am - 4:00pm Compressed/Flexible Schedule: Flexible Position Description Title/PD#: Lead Legal Admin Specialist/PD05079A Relocation/Recruitment Incentives: Not authorized

Requirements

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 02/09/2024. EXPERIENCE: A specific length of training and experience is not required, but you must show evidence of training or experience of sufficient scope and quality of your ability to do the work of this position. Evidence which demonstrates you possess the knowledge, skills, and ability to perform the duties of this position must be supported by detailed descriptions of such on your resume. Applicants will be rated in accordance with the OPM Federal Wage System Qualification Standards. 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/Working Conditions: The work is primarily sedentary, although some walking, stooping, bending, reaching and carrying of loads up to 20 pounds is required . Use of a computer is extensive.

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: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

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]