Job Description
Paralegal ROLE We need an experienced Legal Professional at the Centers for Medicare & Medicaid Services (CMS). CMS’s Office of Hearings (OH) is responsible for adjudicating appeals and applications related to the Medicare Advantage Risk Adjustment Data Validation (RADV) and the Medicare Geographic Classification Review Board (MGCRB). In this role, you will provide legal and adjudicative support to CMS Hearing Officers and Board Members, including case review, analysis, legal research, drafting memoranda and proposed decisions, and managing case documentation in OH’s Case and Document Management System (CDMS). This is a full-time opportunity. We can offer a competitive salary, and a comprehensive benefits package.
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RESPONSIBILITIES - Review and analyze appeal requests, briefs, motions, and supporting documentation for completeness, adequacy, and jurisdiction under applicable CMS regulations
- Perform legal and regulatory reviews to determine the validity of hearing requests and identify procedural or substantive issues requiring Hearing Officer attention
- Draft legal memoranda, bench memoranda, and decision recommendations incorporating statutory and regulatory analysis, citations, and recommendations for disposition
- Support pre-hearing and hearing processes by scheduling conferences, preparing notices, and recording proceedings for CMS internal use
- Summarize hearing discussions, track rulings, and prepare written decision drafts consistent with CMS standards and legal precedent
- Prepare proposed final decisions for Hearing Officer or MGCRB review, ensuring clarity, accuracy, and adherence to CMS legal and procedural requirements
- Review MGCRB applications for completeness and compliance and applicable wage index and reclassification criteria
- Conduct substantive reviews of hospital reclassification requests and prepare recommendations for MGCRB consideration
- Document and manage case actions, communications, and determinations in the OH CDMS to ensure accurate tracking and auditability
- Coordinate with CMS officials and the Office of the Attorney Advisor regarding post-decision actions, appeals, and final determinations
REQUIRED SKILLS/EXPERIENCE - 3+ years of experience drafting legal briefs and/or memoranda
PREFERRED EDUCATION / CERTIFICATIONS - A.A. in Legal Studies (or higher), Paralegal certificate, or equivalent
LOCATION CLEARANCE CLIENT - Centers for Medicare and Medicaid Services’ (CMS), Office of Hearings (OH)
TRAVEL WORK HOURS - Full time = 40 hours a week, 8 hours a day
EMPLOYMENT CLASSIFICATION RELOCATION - Not eligible for relocation benefits.
West 4 th Strategy is an Equal Opportunity (EEO) employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, gender, sexual orientation, ancestry, national origin, age, marital status, mental disability, physical disability, medical condition, pregnancy, political affiliation, military or veteran status, or any other basis prohibited by federal or state law. Other Considerations: applicants will be subject to a background investigation. Individual’s primary workstation is in an office area. The noise level in this environment is low to moderate. Regularly required to sit for extended periods up to 80% of the time; frequently required to move about to access file cabinets and use office equipment such as PC, copier, fax, telephone, cell phone, etc. Occasionally required to reach overhead, bend, and lift objects of up to 10 lbs. Specific vision abilities required by this job include the use of computer monitor screens up to 80% of the time.
Job Tags
Full time, Work at office, Relocation, Relocation package,