"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. The Supervisory Administrative Law Judges (ALJs) within OMHA issue the decision of the Secretary on appeals involving Medicare Parts A, B, C, and D, entitlements and premium rate increases.
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OMHA nationally administers the third level of appeals for the Medicare program. The Supervisory Administrative Law Judges (ALJs) within OMHA 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, entitlements and premium rate increases.
OMHA provides the basic mechanisms through which individuals and organizations dissatisfied with Medicare determinations affecting their rights in the Medicare program may obtain a hearing under the Social Security Act on these determinations. The OMHA offices incorporate state of the art video-teleconferencing and audio-teleconferencing technologies, automated data reporting and case management systems, and a variety of other office automation and IT technologies to aide Supervisory ALJs and their staff in the adjudication of Medicare appeals.
In conformity with the Administrative Procedures 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.
Supervisory ALJs are assigned cases of varying difficulty on a rotational basis and it is the responsibility of the Supervisory ALJ to hold Administrative Procedure Act hearings as appropriate and produce legally and technically accurate decisions on all cases within applicable statutes and regulations. If selected to serve as a Supervisory ALJ for OMHA, you will supervise the day-to-day opertaions of a hearing team in an OMHA field office. Supervisory ALJs are also responsible for operating in a fully electronic, state of the art hearing office environment.
Occasional travel - You may be expected to travel for this position.
Adjudicators, Administrative Law
Administrative Law Adjudicators
Administrative Law Judges
Judges, Administrative Law
MANDATORY QUALIFICATION: Candidates must currently hold an Administrative Law Judge (ALJ) position, at the AL-3 level or above.
Desirable Qualifications (DQs): The Expression of Interest, which is one of the required documents for this vacancy announcement, should be formatted so that each desirable qualification is individually addressed.
Demonstrated ability to adjudicate a high volume of cases ranging from simple disputes to highly complex contested cases in a timely fashion.
Demonstrated ability to understand, analyze, decide and communicate difficult and complex technical, legal and factual issues.
Demonstrated ability to communicate orally in a clear and precise matter while exhibiting appropriate judicial temperament.
Demonstrated ability to produce a comprehensive legally and technically defensible agency decision involving complex technical, legal and factual issues written in a clear and precise manner.
Demonstrated ability to lead and supervise staff in an effective manner in order to accomplish stated goals.
Demonstrated knowledge of Medicare issues is helpful.
All Mandatory Qualification requirements must be met by the closing date of this announcement.
This job does not have an education qualification requirement.
Department Of Health And Human Services