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Carrot Peelers, Sales, Personality and Your Job Search
Government
Attorney
Health Care
Min 4 yrs required
Hearings Officer II Duties : Conducts various types of hearings of adverse determinations, including but not limited to, reconsideration reviews of adverse determinations for Medicaid and Health Choice Providers by the Department of Health and Human Services, Division of Health Benefits and its vendors; appeals by residents who are being transferred or discharged from an adult care home or skilled nursing facility; appeals of Preadmission and Resident Review (PASRR) level II determinations; and second level external reviews of medical service denials or reductions for Health Choice beneficiaries. Review and process information and render accurate, impartial, and well supported decisions in accordance with Medicaid policy and State and Federal laws and regulations. Coordinate efficient scheduling of hearings with parties. Examine appeal documentation and pertinent laws and policies for each appeal case assigned. Conduct hearings in-person, telephonic, and paper appeals impartially and efficiently. Compose well-supported hearing decisions with tact and clarity using case-specific, relevant facts and the applicable rules, laws, regulation and policies. Provide overview and training of appeal process to internal and external partners. Assist in rules reviews pertaining to hearing processes and other duties as directed.
Qualification and Experience
Qualification : Should have Bachelor s degree from an appropriately accredited institution and 4+ years of experience in administrative adjudication proceedings; or an equivalent combination of education and experience. Degrees must be from appropriately accredited colleges or universities. Preferred adjudication experience with Medicaid provider claims or other similar experience. Legal training and knowledge of Medicaid policies and relevant State and federal law and regulations applicable to Medicaid and Health Choice Providers is preferred. 6+ months of experience conducting Medicaid provider appeals is preferred. Juris Doctor preferred.
POSITION NUMBER: 60042600
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