This position is located in the Department of Health and Human Services, Departmental Appeals Board, headquartered in Washington, District of Columbia.Learn more about this agency
The incumbent serves as an Administrative Appeals Judge (AAJ) at the final administrative level of appeal in Medicare cases brought before the Medicare Appeals Council (Council) of the Departmental Appeals Board (DAB). Appeals can be filed with the Council after actions have been issued by the HHS Office of Medicare Hearings and Appeals (OMHA), Social Security Administration (SSA), or HHS Centers for Medicare & Medicaid Services (CMS). In accordance with a delegation of authority from the Secretary of HHS and consistent with the Administrative Procedure Act, AAJs render final administrative decisions which may be subject to judicial review in federal district court.
If selected for this position, you will be appointed by the Secretary of Health and Human Services, and will perform the following duties:
- Render decisions on appealed hearing decisions or remanded court cases involving health insurance benefits under Titles XI or XVIII of the Social Security Act arising from decisions issued by the SSA or OMHA Administrative Law Judges (ALJs);
- Dismiss, deny, or grant requests for review of ALJ decisions/dismissals or deny or grant requests for own- motion review, and issue decisions affirming, modifying, or reversing hearing decisions/dismissals, acting with other AAJs;
- Remand appeals to ALJs with directions to take specific actions;
- Decide appeals involving a wide variety of physical and mental conditions and the appropriate level of care necessary to treat those conditions, and the eligibility for payment to be made for equipment and services under Medicare and Medicaid;
- Research statutes, regulations, case law, policies, coverage determinations, and legal opinions related to specific legal issues that arise in appeals;
- Analyze briefs, exhibits, medical records, and other documents to evaluate questions of fact and make determinations using applicable legal authorities;
- Study industry and trade practices, policies, procedures; technical and professional publications; and other authoritative sources of information to assist in technical and legal interpretation of relevant question.
- Participate in meetings and case discussions with the Chief AAJ, DAB Chair, and other judges on the Council to ensure consistent application and interpretation of governing law.
- Work collaboratively with MOD attorneys, support staff, and other Council Judges.
- Complete special assignments and projects, as assigned by the DAB Chair or Chief AAJ
AAJs serve under the general administrative direction of the Chief AAJ of the Council and the DAB Chair. All adjudicatory functions are performed in concert with other assigned judges on the Medicare Appeals Council.
Occasional travel - You may be expected to travel for this position.
Job family (Series)
This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/GetJob/ViewDetails/584444000. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered.