Summary This position is located in the Department of Health and Human Services, Departmental Appeals Board, headquartered in Washington, District of Columbia. Responsibilities WHAT YOU'LL BE DOING DAY TO DAY As a Management and Program Analyst, you will use your knowledge and experience to optimize business results and customer experience by: Compiling, organizing, and structuring complex administrative and legal records for adjudication, hearings, and court proceedings, ensuring accurate indexing, logical sequencing, and ease of attorney review. Applying comprehensive knowledge of the Medicare appeals process, supporting case progression at the Federal adjudicative level and ensuring compliance with governing legal and regulatory standards. Preparing, finalizing, and releasing legal decisions, interim notices, agency referrals, and official correspondence, ensuring accuracy, completeness, and adherence to procedural standards. Compiling, organizing, and structuring complex administrative and legal records for adjudication, hearings, and court proceedings, ensuring accurate indexing, logical sequencing, and ease of attorney review. Leading and supporting large-scale legal file digitization initiatives, converting extensive volumes of legacy paper case files into secure electronic systems while maintaining document integrity and record accuracy. Requirements Conditions of Employment Qualifications WHAT WE ARE LOOKING FOR You must have one year of specialized experience equivalent to at least the GS-07 grade level in the Federal service, obtained in either private or public sector, performing ALL of the following: Producing data-driven reports, findings, recommendations, and workflow solutions to support case processing, program operations, or administrative activities. Applying Medicare case management procedures, adjudicative workflows and regulatory requirements governing third and fourth level Medicare appeals to process and manage cases. Preparing formal correspondence, notices, referrals, acknowledgment letters, or other official documents while ensuring accuracy, completeness, and adherence to established procedures and standards associated with Medicare caseloads. Interpreting and applying regulatory, procedural, or administrative guidance to determine appropriate actions and ensure work was processed in compliance with legal and organizational requirements relating to Medicare caseloads. Utilizing electronic case management systems, shared drives, digital filing systems, and other automated tools to organize, track, maintain, and communicate case or program information to attorneys, leadership, contractors, and external stakeholders. OR Have 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. One year of full-time graduate education is considered to be the number of credit hours that the school attended has determined to represent 1 year of full-time study. If that information cannot be obtained from the school, 18 semester hours should be considered satisfying the 1 year of full-time study requirement. Part-time graduate education is creditable in accordance with its relationship to a year of full-time study at the school attended. OR Have a combination of education and experience as described above that meets 100% of the requirements. Documenting experience: IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Qualifications are based on breadth/level of experience. In addition to describing duties performed, applicants must provide the exact dates of each period of employment (from MM/YY to MM/YY) and the number of hours worked per week if part time. As qualification determinations cannot be made when resumes do not include the required information, failure to provide this information may result in disqualification. Applicants are encouraged to use the USAJOBS Resume Builder to develop their federal resume. Do not copy and paste the duties, specialized experience, or occupational application questionnaire from this announcement into your resume as that will not be considered a demonstration of your qualifications for this position. 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. OPM Qualification General Policies Website Education 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: http://www.ed.gov. Note: Applications can be accepted from students who expect to complete qualifying education within 9 months from the date of application. Education was completed successfully before the applicant can be appointed. Additional Information THINGS YOU NEED TO KNOW Incentives may be authorized; however, this is contingent upon multiple factors, including funds availability. If authorized, certain incentives may require you to sign a service agreement to remain in the Federal government for a period of up to 3 years. Note: This statement does not imply nor guarantee an incentive will be offered and paid. Incentives may include the following: moving expenses, recruitment or relocation incentive; student loan repayment, superior qualifications appointment, creditable service for annual leave for prior non-federal work experience or prior uniformed military service, etc. Bargaining Unit Position: No Research position: No Drug Screening Required: No Special Hiring Authorities for Veterans - https://www.usajobs.gov/Help/working-in-government/unique-hiring-paths/veterans/ Special Hiring Authorities for Military Spouses - https://www.usajobs.gov/Help/working-in-government/unique-hiring-paths/military-spouses/ People With Disabilities (Schedule A) - https://help.usajobs.gov/index.php/Individuals\with\Disabilities Career Transition Assistance Program/Interagency Career Transition Assistance Program (CTAP/ICTAP): For information on how to apply as an CTAP/ICTAP eligible see http://opm.gov/rif/employee\guides/career\transition.asp#ictap. To be well-qualified and exercise selection priority for this vacancy, displaced Federal employees must be rated at 85.0 or above on the rating criteria for this position. 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. For additional information about USAJOBS visit the Help Center: https://www.usajobs.gov/Help/USA Hire Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable\Accommodations\for\USA\Hire
