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Deputy Chief Administrative Law Judge

Company: Office of the Secretary of Health and Human Servic
Location: arlington
Posted on: May 3, 2021

Job Description:

Summary

"OMHA is a responsive 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 healthcare." OMHA nationally administers the third level of appeals for the Medicare program. OMHA ALJs issue the decision of the Secretary (except for decisions reviewed by the Medicare Appeals Council) on appeals involving Medicare Parts A, B, C, and D, and entitlements.

Responsibilities

In conformity with the Administrative Procedure Act, 5 U.S.C. 551, et. seq. as well as the Medicare provisions of the Social Security Act and their attendant regulations, OMHA ALJs make pre-hearing rulings, preside over formal hearings, decide post-hearing matters, and issue written decisions under authority delegated by the Secretary of HHS. Issues on appeal arise from Medicare coverage and payment determinations made by Medicare contractors, Medicare Advantage Organizations (MAOs), or Part D Plan Sponsors (PDPSs), and determinations related to Medicare eligibility and entitlement, and income-related premium surcharges made by the Social Security Administration (SSA) under sections 1869, 1155, 1876(c)(5)(B), 1852(g)(5), and 1860D-4(h) of the Social Security Act. The appeals are frequently complex, require the interpretation and application of federal statutes, regulations, and program policy, may be contested, and are subject to demanding time constraints. The DCALJ is accountable to the CALJ and provides leadership and coordination of OMHA activities. Provides the professional guidance and executive leadership necessary to assure the thorough, yet most expeditious, processing of all Medicare claims hearing requests filed with OMHA. Leads the OMHA day-to-day operations and oversees the development of OMHA policies and standard operating procedures. The DCALJ is accountable for the organization's overall performance and sets the workforce's expected performance level consistent with statutory timeframes and other regulatory mandates. Assures that hearing proceedings conducted by the field office are in accord with procedural requirements of the Administrative Procedure Act and applicable Federal laws and HHS regulations. Monitors the status of pending cases and recommends reasonable standards of quality, output, and productivity to assure the timely and expeditious processing of those cases to meet the Part A and B 90-day decisional timeframes. Presides at hearings in some of the most difficult and controversial proceedings; develops the record in such proceedings from oral testimony and documentary evidence; independently studies and analyzes the evidence; and prepares decisions containing findings of fact, supporting rationale, conclusions of law, and resolution of the appeal. Provides technical procedural guidance to ALJs and to other field office employees. Designs, develops, and implements strategies that will maximize the effective use of human resources, financial assets and technology to deliver quality Medicare claims hearings. Maintains a work environment that is safe, healthy, and culturally diverse. Ensures all employees are provided with the tools and developmental opportunities to develop their professional skills to contribute to the achievement of OMHA's organizational goals and objectives. Provides executive oversight for the direction of ALJ training. Serves as the agency's most senior subject-matter-expert and resolves the most complex legal and policy training issues. Recommends which ALJs be hired. Investigates allegations of improper conduct and recommends appropriate remedial actions.

Requirements

Conditions of Employment

  • 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 choosing. 4. All Mandatory Qualification requirements must be met by the closing date of the announcement. 5. A financial disclosure statement is required. 6. Travel, transportation, and relocation expenses may be paid: Yes 7. Bargaining Unit Position: No 8. Drug Screening Required: No 9. Recruitment incentives may be authorized: No 10. Student loan repayment incentive authorized:No 11. Annual leave for non-federal service authorized: No 12. U.S. Citizenship required 13. The candidate selected for this position will be in the excepted service unless the candidate is currently an OMHA ALJ in the competitive service. In that situation, per OPM guidance, the candidate will remain in the competitive service.
  • Qualifications

    MANDATORY QUALIFICATION: Candidates must have held a Federal ALJ position, at the AL-3 level or above for at least one year. Licensure Requirement: Former ALJs at the time of application, must possess a professional license to practice law and be authorized to practice law under the laws of a State, the District of Columbia, the Commonwealth of Puerto Rico or any territorial court established under the United States Constitution. Please read the required documents section closely for information on what you need to submit as proof that you are licensed and authorized to practice law. Desirable Qualifications (DQs): As stated in the required documents section below, candidates must submit a written narrative that addresses each of the desirable qualifications listed below. The written narrative must be formatted so that each desirable qualification is individually addressed. Responses for each desirable qualification should be no more than one page in length. Experience in providing professional guidance, executive leadership, and oversight of adjudicatory hearings. Experience in overseeing and directing programs, issuing policies and procedures. Broad legal knowledge and ability to develop quickly a specialized knowledge of the Medicare program, law, adjudication procedures, and related matters. Experience in analyzing and deciding extremely difficult and complex technical, legal and organizational issues. Ability to lead strategic change in a continuously changing environment. Ability to lead an organization while fostering inclusivity, creativity, cooperation and teamwork.

    Education

    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 contact the HR 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/ Males born after December 31, 1959 must be registered or exempt from Selective Service - http://www.sss.gov 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. Veterans' Preference: There is no formal rating system for applying veterans' preference to ALJ appointments in the excepted service; however the Department of Health and Human Services considers veterans' preference eligibility as a positive factor in ALJ hiring. Applicants eligible for veterans' preference must include that information in their resume and attach supporting documentation (e.g. the DD-214 Certificate of Release or Discharge from Active Duty (Member 4 copy) and other supporting documentation) to their submissions. Although the "point" system is not used, per se, applicants eligible to claim 10 point preference must submit Standard Form SF-15, Application for 10 point Veteran Preference, and submit the supporting documentation required for the specific type of preference claimed (visit the OPM website, www.opm.gov/forms/pdf_fill/SF15.pdf for a copy of SF-15 which lists the types of 10-point preferences and the required supporting documents). Applicants should note that SF-15 requires supporting documentation associated with service-connected disabilities or receipt of non-service-connected disability pensions to be dated 1991 or later except in the case of service members submitting official statement or retirement orders from a branch of the Armed Forces showing that his or her retirement was due to a permanent service-connected disability or that he/she was transferred to the permanent disability retired list (the statement or retirement orders must indicate that the disability is 1-% or more). 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.

Keywords: Office of the Secretary of Health and Human Servic, Arlington , Deputy Chief Administrative Law Judge, Other , arlington, Virginia

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