The Office of Medicare Hearings and Appeals (OMHA) administers the third level of appeals nationwide for the Medicare program, ensuring that beneficiaries, providers, and suppliers have access to an independent forum and an opportunity for a hearing. OMHA's mission is to be a responsible forum for fair, credible and timely decision-making through an accomplished, innovative and resilient workforce. Each employee makes a difference by contributing to shaping American health care.

Duties

The Legal Administrative Specialist in the Appeals Policy and Operations Division (APOD) performs the following duties: Organizes Medicare adjudication case files for distribution. Prepares responses to appellants on adjudication results and processes. Identifies case processing challenges with pending appeals. Interprets data from appellants and/or appellant's representatives. Tracks case file development.

Requirements

Qualifications

Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration. Please limit your resume to 5 pages. If more than 5 pages are submitted, only the first 5 pages will be reviewed to determine your eligibility/qualifications. To qualify at the GS-09 you must meet one of the descriptions below: Have 52 weeks of specialized experience at the GS-07 level performing the following duties: organizing and managing legal administrative cases; reviewing cases and making recommendations on appropriate case file organization; communicating with appellants or their representatives in writing or in person; tracking case development to verify case milestones are progressing; and working in a highly automated office environment. OR Have successfully completed 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, in a field which demonstrates the knowledge, skills, and abilities necessary to perform the work of the positions. OR Have the specialized experience as describe in A, but less than one year; and I have at least one year of graduate education as described in B, but less than the required two years. I have computed the percentages of the requirements that I meet, and the total is at least 100%. (To compute the percentages, divide your total months of qualifying experience by 12. Then, divide your semester hours of graduate education beyond the first year (total graduate semester hours minus 18) by 18. Add the two percentages. The total percentages must equal at least 100% to qualify.) (Note: You must attach a copy of your transcripts.) Time-in-grade: Current General Schedule (GS) federal employees, and those that have served in GS positions within the last 52 weeks, must have served 52 weeks at the next lower grade, or a combination of the next lower grade level and an equivalent band in the federal service. Provide a copy of your last or most recent SF-50, "Notification of Personnel Action" to indicate your current federal status. You must also submit additional SF-50(s) to clearly demonstrate one year time-in-grade as required in the announcement. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate that you possess one year time-in-grade. In this instance, you must provide an additional SF-50 that clearly demonstrates one year time-in-grade. Documenting experience: In accordance with Office of Personnel Management policy, federal employees are assumed to have gained experience by performing duties and responsibilities appropriate for their official series and grade level as described in their position description. Experience that would not normally be part of the employee's position is creditable, however, when documented by satisfactory evidence, such as a signed memorandum from the employee's supervisor or an SF-50 or SF-52 documenting an official detail or other official assignment. The documentation must indicate whether the duties were performed full time or, if part time, the "percentage of times" the other duties were performed. It is expected that this documentation is included in the employee's official personnel record. In order to receive credit for experience in your resume that is not within the official series and grade level of your official position, you must provide a copy of the appropriate documentation of such experience as indicated above. 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; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to gain employment. You will receive credit for all qualifying experience, including volunteer experience. If such experience is on a part-time basis, you must provide the average number of hours worked per week as well as the beginning and ending dates of the experience so it can be fully credited.

Education

If education is required or you are using education to qualify, you must submit a copy of your college transcripts. An unofficial copy is sufficient with the application; however, if you are selected, you will be required to submit official transcripts prior to entering on duty. Education must have been successfully obtained from an accredited school, college or university.

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 a private organization that specializes in interpretation of foreign education programs and such education has been deemed equivalent to that gained in an accredited U.S. education program; or full credit has been given for the courses at a U.S. accredited college or university. For further information, visit: https://www2.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html. All transcripts must be in English or include an English translation.

Contacts

• Address Office of Medicare Hearings and Appeals Presidential Tower 2550 South Clark Street Arlington, VA 22202 US
• Name: OMHA Human Resources Center
• Email: [email protected]