Hearings Officer
The Hearing Officer conducts various types of appeal hearings and reconsideration reviews, including reconsideration reviews of adverse determinations by the Division of Health Benefits and its vendors against Medicaid and Health Choice providers; 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 reviews of the denial, termination, or suspension of Medicaid provider enrollment. This position does not handle beneficiary appeals. The Hearing Officer reviews and processes information and renders accurate, impartial, and well-supported decisions in accordance with Medicaid policy and State and Federal laws and regulations.
Job Specific Responsibilities
• Coordinate efficient scheduling of hearings with parties
• Examine documentation and pertinent laws and policies for each case assigned
• Conduct in-person, telephone, and paper appeals impartially and efficiently
• Compose well-supported decisions with tact and clarity using case-specific, relevant facts and applicable rules, laws, regulations, 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
Management prefers:
• Knowledge of Medicaid policies and relevant State and Federal law and regulations
• Juris Doctor degree strongly preferred
Minimum Education and Experience Requirements:
Bachelor's degree from an appropriately accredited institution and four (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.