Summary 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. Responsibilities Please note: The selectee will continue to sit in their current office location. Incumbent serves as a Senior Attorney Advisor in the Appeals Policy and Operations Division (APOD) performing the following duties: Provides expert technical legal advice, research, and guidance in the formulation, development, and implementation of OMHA policies related to appeal processing, agency guidance, and certain operational procedures. Handles novel issues in application and interpretation of laws and regulations governing Medicare coverage and payment claims under Part A, B, C, and D, as well as IRMAA and entitlement claims and disputes of Part B and D premium surcharges. Works on highly complex problems, proposed legislation, or proposed changes in Medicare policies or regulations that may affect OMHA appeals processing, operations, and/or the adjudication process OMHA administers. Researches statutes, legislative history, public policy implications, precedent cases, applicable regulations, and procedures; and demonstrates the ability to convey clear legal analysis. Reviews and comments on proposals for changes to new or existing adjudication policies and procedures affecting OMHA appeal processing. Contributes to developing, reviewing, and delivering agency-wide presentations. Coordinates on data analytics impacting OMHA adjudicative policies, agency goals, operational matters, data integrity, and workload management. Produces well-researched and well-written memoranda. Communicates effectively with OMHA managers, OMHA staff, Medicare stakeholders, and external entities. Serves as a liaison between APOD and other divisions within Headquarters. Requirements Conditions of Employment Must maintain active bar membership in good standing and the eligibility to practice law in a State, territory, Commonwealth of Puerto Rico, District of Columbia, or Federal Court throughout employment with the Office of Medicare Hearings and Appeals. 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. 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. Direct Deposit: All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choice. All qualification requirements must be met by the closing date of the announcement. Financial disclosure statement may be required: Yes Travel, transportation, and relocation expenses may be paid: No Bargaining Unit Position: No Drug Screening Required: No Recruitment incentives may be authorized: No Student loan repayment incentive may be authorized: No Annual leave for non-federal service may be authorized: No Two (2) year trial period may be required. U.S. Citizenship Required: Yes Males born after December 31, 1959 must be registered or exempt from Selective Service - http://www.sss.gov This position is in the Excepted Service and will not be converted into a permanent position in the competitive service. Qualifications Your resume must not exceed two (2) pages. If your resume exceeds the two-page limit, you will be removed from consideration for this announcement. Minimum Qualification Criteria for Attorneys: EDUCATION: Successful completion of a full course of study in a school of law accredited by the American Bar Association through which you have attained the first professional law degree, i.e. LLB, or J.D. NOTE: 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 the conferred/awarded date Self-prepared transcripts will not be accepted. Official transcripts are required prior to appointment. BAR MEMBERSHIP: All attorney positions require current active bar membership. Admission to the bar of any State, territory, Commonwealth of Puerto Rico, District of Columbia, or Federal Court is acceptable. Employees must maintain active bar membership while employed as an attorney with HHS/OMHA. NOTE: You MUST provide proof that you are authorized to practice law. Failure to provide proof will result in an ineligible rating. Such proof can include: An active bar card that shows the current year or an expiration date outside of the closing date of the announcement. If the card only shows a previous year (example: 2025), you must submit additional documentation. A screen print from a bar website that reflects you are an active member of the bar. The screen print must make clear what month, date, and year the screen print was taken. A letter/certificate from the bar certifying that you are licensed and authorized to practice law. The letter must be dated within one year of the closing date of the announcement. Grade Specific Qualifications: GS-13: In addition to the minimum qualifications above for the GS-13 Senior Attorney Advisor position, candidates must have two (2) years of professional legal experience after admission to the bar commensurate with the duties of the position and at least one year of experience that is equivalent to the GS-12 grade level in the Federal service. 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 EDUCATION: Successful completion of a full course of study in a school of law accredited by the American Bar Association through which you have attained the first professional law degree, i.e. LLB, or J.D. 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. Additional Information 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: This program 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 or ICTAP; 2) be rated well-qualified for the position; and 3) submit the appropriate documentation to support your CTAP or ICTAP 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.
