Legal Administrative Specialist

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.

Salary

• $59,966 - $90,647/year

Conditions of Employment

1. Security and Background Requirements: If not previously completed, a background security investigation will be required for all appointees. Appointment will be subject to the applicant's successful completion of a background security investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a background security reinvestigation or supplemental investigation may be required at a later time. Applicants are also advised that all information concerning qualifications is subject to investigation. False representation may be grounds for non-consideration, non-selection and/or appropriate disciplinary action.
2. E-Verify: If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the DHS "E-Verify" System. Federal law requires DHS to use the E-Verify System to verify employment eligibility of all new hires and as a condition of continued employment obligates the new hire to take affirmative steps to resolve any discrepancies identified by the system. The U.S. Department of Health and Human Services is an E-Verify participant.
3. Direct Deposit: All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choice.
4. All qualification requirements must be met by the date the announcement closes.
5. Financial disclosure statement may be required: No
6. One-year probationary period may be required.
7. Travel, transportation, and relocation expenses may be paid: No
8. Bargaining Unit Position: Yes
9. Drug Screening Required: No
10. Recruitment incentives may be authorized: No
11. Student loan repayment incentive may be authorized: No
12. Annual leave for non-federal service may be authorized: No
13. U.S. Citizenship Required: Yes
14. Males born after December 31, 1959 must be registered or exempt from Selective Service - http://www.sss.gov

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. Other Information

Special Hiring Authorities for Veterans - http://www.fedshirevets.gov/job/shav/index.aspx

People With Disabilities (Schedule A) - https://www.usajobs.gov/Help/working-in-government/unique-hiring-paths/individuals-with-disabilities/

Reasonable Accommodation: This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application and hiring process, please see Agency Contact Information for whom to contact for more info. The decision on granting reasonable accommodation will be made on a case-by-case basis. You must email the agency contact on the vacancy announcement at least three business days before the closing date of this announcement to receive assistance.
For more information on disability employment, please visit https://www.opm.gov/policy-data-oversight/disability-employment/

Career Transition Program (CTAP): Applies to Federal service employees whose positions have been deemed surplus or no longer needed, or employees who have been involuntarily separated from a Federal service position within the competitive service. To receive selection priority for this position, you must: 1) meet eligibility criteria for CTAP; 2) be rated well-qualified for the position; and 3) submit the appropriate documentation to support your CTAP eligibility. Well-Qualified includes those applicants whose knowledge, skills, and abilities clearly exceed the minimum qualification requirements for the position. For information on eligibility criteria and required documentation, go to: http://www.opm.gov/rif/employee_guides/career_transition.asp

Beginning January 1, 2010, agencies must seek prior approval from OPM before they can appoint a current or recent political appointee to a competitive or non-political excepted service position at any level under the provisions of title 5, United States Code. If you are currently or have been within the last 5 years, a political Schedule A, Schedule C, or Non-career SES employee in the executive branch, you MUST disclose that to the Human Resources Office.

In accordance with Executive Order 12564 of September 15, 1986, The Department of Health and Human Services (HHS) is A Drug-Free Federal Workplace. The Federal government, as the largest employer in the Nation, can and should show the way towards achieving drug-free workplaces through programs designed to offer drug users a helping hand, and at the same time demonstrating to drug users and potential drug users that drugs will not be tolerated in the Federal workplace. The use of illegal drugs, on or off duty, by Federal employees is inconsistent not only with the law-abiding behavior expected of all citizens, but also with the special trust placed in such employees as servants of the public. Applicants selected for this position will be subject to reasonable suspicion and post-accident drug testing upon hiring. To demonstrate commitment to the HHS goal of a drug-free workplace and to set an example for other Federal employees, employees not in a testing designated position may volunteer for unannounced random testing by notifying their Drug-free Federal Workplace Program Point of Contact upon hiring.

Required Documents

Submission of a resume alone IS NOT a complete application. You must provide a complete online Application Package which includes:

• Your Resume must clearly articulate how your skills and experiences align to the criteria defined in the qualifications section of this announcement and it must support your responses to the assessment questionnaire. For each position you must describe your duties, accomplishments, related skills, and responsibilities. Your resume must also include the month and year that you began and ended for each position held. Full-time employment will be assumed unless otherwise stated on your resume. Part-time employment will be prorated in crediting experience. Not providing this information may result in the lowering of your assessment score or an ineligible rating. 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. For resume writing guidance, please visit the USAJobs Resource Center.
• SF-50 "Notification of Personnel Action" - you must submit an SF-50 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.
• A complete Assessment Questionnaire (https://apply.usastaffing.gov/ViewQuestionnaire/12612671)

Other Supporting Documents: (Only Submit if applicable to you)

• Transcripts (if qualifying based on education). A transcript is required to substantiate possession of the required and claimed education. Unofficial transcripts (including screen-prints from your school's web portal) are acceptable for initial application; however the unofficial transcript must show your name, the name of the educational institution, the degree awarded, and the conferred/awarded date. Self-prepared transcripts will not be accepted. Official transcripts are required prior to appointment.
• Schedule A documentation (disability letter from you doctor or a licensed medical professional that proves your eligibility for Schedule A appointment.
• Veterans: You must submit a DD Form 214 (Certificate of Release or Discharge) that has the dates of service and discharge status.
  • Disabled Veterans: In addition to the DD-214 form, you must submit an official document dated 1991 or later, from the Department of Veterans Affairs or from a branch of the Armed Forces, certifying the service-connected disability rating.
• CTAP documentation: you must submit the following documents at the time of application: (1) Proof of Eligibility (Reduction-in-Force separation notice, Notice of proposed removal for failure to relocate, notice of injury compensation termination, OR notice of disability annuity termination); (2) Your latest performance rating showing a rating of at least "fully successful" (level 3); AND (3) Your most recent Notification of Personnel Action, Standard Form 50 (SF-50), or equivalent personnel action, showing your tenure, position occupied, and duty station.

You are not required to submit official documents at this time; copies are sufficient.

How to Apply

To apply for this position, you must complete the occupational questionnaire and submit the documentation specified in the Required Documents section.

*To begin, click Apply Online to create a USAJOBS account or log in to your existing account. Follow the prompts to select your USAJOBS resume and/or other supporting documents and complete the occupational questionnaire.
*Click the Submit My Answers button to submit your application package.
*It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.

To verify your application is complete, log into your USAJOBS account at https://my.usajobs.gov/Account/Login, select the Application Status link, and then select the more information link for this position. The Details page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process.

To return to an incomplete application, log into your USAJOBS account at https://my.usajobs.gov/Account/Login and click Update Application in the vacancy announcement. You must re-select your resume and/or other documents from your USAJOBS account or your application will be incomplete.

If you are unable to apply online, please go to https://help.usastaffing.gov/Apply/index.php?title=Alternate_Application_Information for more information on our alternate application method.

The complete Application Package must be submitted by 11:59 PM (EST) on 12/04/2024.

Benefits

A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Learn more about federal benefits.

Review our benefits