Appeals & Grievances Administrator
|Department||MD Health Benefit Exchange|
|Date Opened||11/17/2020 08:00:00 AM|
|Filing Deadline||12/1/2020 11:59:00 PM|
|Salary||$46,942.00 - $60,785.00 with growth potential to $74,933.00/year|
|HR Analyst||Tammy Austin|
LOCATION OF POSITION
750 E. Pratt Street, 6th Floor, Baltimore, Maryland 21202
The candidate hired for this position will work remotely while State offices remain in Elevated Level II - Flexible Operations due to the COVID-19 pandemic.
Main Purpose of Job
Conduct research and adjudicate a caseload of appeals of individuals, business and/or providers. Interview applicants and representatives associated with investigation.
Analyze pertinent facts against appropriate regulatory and policy provisions and develop written recommendations to management for the appeal decision.
Develop the supporting case file, in consultation with legal staff, for appeals that escalate to a review by an Administrative Law Judge from the Office of Administrative Hearings. Provide support for adjudication of appeals and hearings as required.
Prepare written reports analyzing alternatives and consequences, specifying findings and recommendations for management action, strategy, policy determinations and process changes.
Provide extensive interpretation of state and federal eligibility statutes, regulations, policies and guidelines to the administrative vendor, enrolled subscribers and the general public.
Conduct review of eligibility appeal requests and supporting documentation, coordinate data collection with appellants perform general case management.
Education: A Bachelor's degree from an accredited college or university.
Experience: Four years of related experience in administrative staff or professional work.
1. Additional experience in administrative staff or professional work may be substituted on a year-for-year basis for the required education.
2. Additional graduate level education at an accredited college or university may be substituted at the rate of 30 semester credit hours on a year-for-year basis for the required experience.
3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer involving staff work related to the administration of rules, regulations, policy, procedures and processes, or overseeing or coordinating unit operations or functioning as a staff assistant to a higher ranking commissioned officer on a year-for-year basis for the required education and experience.
DESIRED OR PREFERRED QUALIFICATIONS
Two years experience specializing in Appeals & Grievances Hearing process.
Extensive knowledge of the Affordable Care Act and Medicaid.
Must be able to travel to and attend hearings in all 24 counties within the State of Maryland.
LICENSES, REGISTRATIONS AND CERTIFICATIONS
Employees in this classification will be assigned duties that require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator's license valid in the State of Maryland.
Applicants who meet the minimum and selective qualifications will be included in further evaluation. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment and may be requested prior to interview. Successful candidates will be ranked as Best Qualified, Better Qualified, or Qualified and will remain on the certified eligible list for a period of at least one year.
The examination will consist of a rating of your education, training, and experience as presented on your application and as they relate to the requirements of the position. You may be required tocomplete a supplemental question. Therefore, it is important that you provide complete and accurate information on your application. For education obtained outside the U.S., a copy of the equivalent American education as determined by a foreign credential evaluation service will be required before the time of hire.