Legal Administrative Specialist

Full Job Description

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. Please limit your resume to 2 pages.

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.

Specialized Experience: To be eligible at the GS-9 position, you must have one year of specialized experience that is equivalent to at least the GS-7 grade level performing duties such as: completing quality control of case records and evaluating completeness of case records; using reports to identify and elevate priority workflow processing; researching legal case filing anomalies and recommending appropriate action; explaining case processing procedures to internal and external stakeholders; and researching and responding to appellants or their representatives' inquiries.

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 described above, but less than one year; and have at least one year of graduate education as described above, but less than the required two years.

(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.

Major Duties:

The Legal Administrative Specialist performs the following duties: Reviewing, organizing, and managing complex Medicare appeals cases prior to adjudication assignments.

Gathering, sorting, classifying and interpreting data to provide recommendations for process improvement. Identifying and resolving processing issues with Medicare appeals cases.

Communicating with appellants and their representatives regarding the status of pending appeals. Explaining pertinent regulations and administrative practices to coworkers and stakeholders.