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