Fair Hearing and Appeals Specialist Details

Fair Hearing and Appeals Specialist

State of Idaho - Idaho

Employment Type : Full-Time

Description

The Idaho Department of Health and Welfare, Division of Medicaid is recruiting a highly motivated, customer-focused individual with excellent analytical skills, strong attention to detail, and outstanding communication skills to join the Bureau of Developmental Disability Services (BDDS) as a Medical Program Specialist focused on handling Fair Hearings and Appeals. This position works directly with Medicaid program participants, providers, program staff, contractors, and other stakeholders to promote due process rights, program compliance, and the appropriate delivery of services.
Successful candidates will show initiative and have skills to work independently, while meeting accuracy and productivity standards. This position is characterized by work that is analytical in nature. Incumbents use their professional background to organize, track, and analyze appeal records, related department decisions, policies and documentation. Incumbents conduct research, communicate with appellants, prepare reports, and make recommendations for appeal resolutions.
The location of the position will be based on the applicant selected. This position could be based out of our Coeur d'Alene (Region 1) field office, Lewiston (Region 2) field offices, Caldwell (Region 3) field office, Boise (Region 4) field office, Boise Medicaid Administration office, Twin Falls (Region 5) field office, Pocatello (Region 6) field office or Idaho Falls (Region 7) field office.
This is primarily a Monday through Friday 8am-5pm position. Currently, this job offers telecommuting due to COVID-19.
Why Join Us?

• OUR MISSION: Dedicated to strengthening the health, safety, and independence of Idahoans.
• OUR VISION: Provide leadership for a sustainable, integrated health and human services system.
• OUR VALUES: Integrity, high quality customer service, and compassion are the foundation for all department activities. A focus on these values will lead to success.

We offer a competitive benefits package which includes excellent medical, dental and vision insurance; generous vacation (ability to accrue 3 weeks/year to start) and sick leave accrual beginning as soon as you start; ten paid holidays a year; participation in one of the Nation's best state retirement systems; multiple savings plans and optional 401K; life insurance; wellness programs; ongoing training opportunities; and more.
This announcement will be used to fill the current vacancy only. If you have previously applied for a Medical Program Specialist position, and wish to be considered for the current vacancy, you must reapply under this announcement. Previous scores will not be used.

Example of Duties

• Analyze and interpret complex Medicaid guidelines, policies and procedures
• Interpret and apply Idaho Administrative rules (IDAPA), Idaho Statue, and Code of Federal Regulation
• Serve as the Subject Matter Expert for appeals related to Adult DD eligibility, budgets, and services
• Provide support to other BDDS staff related to resource allocation and budget appeals
• Collaborate with Medicaid policy staff, BDDS program staff, and Deputy Attorneys General in relation to appeals and fair hearings
• Primary point of contact for provider and participant questions and concerns related to appeals and fair hearings

Minimum Qualifications

You must possess all the minimum qualifications listed below to pass the exam for this position. Click on the Questions tab associated with this announcement for the details regarding minimum qualification requirements. The Supplemental Questions on the application are the exam questions. If it is a written answer, please make sure you answer each question with enough detail to determine how you meet the requirements. Do not put see resume as your answer to written questions. Answer each written question thoroughly. Failure to do this may result in not passing the exam and disqualify you from being considered for this position.

• Good Knowledge of medical service delivery systems.
• Some knowledge of current laws and regulations governing Medicaid programs.
• Experience developing instructional materials and giving presentations.
• Experience evaluating program policies and procedures and recommending changes.

Supplemental Information

Additional Qualifications: Are not required, however, having the minimum qualifications and the education and/or experience below will increase your score.

• Experience evaluating program compliance. Gained by at least one year of experience analyzing medical claim and/or service request/utilization management data and preparing both detailed and executive level reports.
• Experience analyzing and implementing medical rules and regulations. Gained by at least one-year experience preparing rules, regulations and/or policy gap analysis documentation.
• Experience working with individuals with developmental disabilities. Gained by at least one-year experience working directly with individuals with developmental disabilities in either an institutional or public setting.
• Experience with Appeals/Legal Procedures. Gained through at least one year of job experience which included participation in appeals processes or other legal procedures. Examples may include experience working directly with administrative appeals or judicial appeals, work experience in a legal or related field (including but not limited to para legal certificate, legal secretary, court assistant, etc.), or similar legal course work.

DEDICATED TO STRENGTHENING THE HEALTH, SAFETY, AND INDEPENDENCE OF IDAHOANS

People Making A Difference!

VISIT US ONLINE
Learn About a Career with DHW
https://healthandwelfare.idaho.gov/about-dhw/dhw-careers

For all Idaho state government jobs:
https://dhr.idaho.gov

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If you have questions, please contact us at:

TROUBLE APPLYING: 1-855-524-5627

(Monday through Friday, 6am - 5pm, Pacific Time)

EMAIL:

dhwjobs@dhw.idaho.gov
(answered Monday through Friday during business hours MST)

Email is the quickest way to get an answer to your questions.

PHONE:

(208) 334-0681
(answered Monday through Friday during business hours MST)

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EEO/AA/Veteran

Hiring is done without regard to race, color, religion, national origin, sex, age or disability. If you need special accommodations to satisfy testing requirements, please contact the Division of Human Resources at (208) 334-2263.

Preference may be given to veterans who qualify under state and federal laws and regulations.