Appeals and Grievance Administrator
|Department||MD Health Benefit Exchange|
|Date Opened||9/10/2021 12:01:00 AM|
|Filing Deadline||9/24/2021 11:59:00 PM|
|Salary||$47,881/yr - $62,001/yr with potential up to $76,432/yr|
|HR Analyst||JasCiel Stamp|
LOCATION OF POSITION
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, and perform general case management for appeals.
- Prepare and present routine appeals cases at OAH.
- Assist OAG, as needed, in the preparation of complex cases for presentation at OAH.
- Perform Case Reviews appeals and special projects for Maryland Health Benefit Exchange.
- Acts as a liaison between local agencies.
Education: A Bachelor's degree from an accredited college or university.
Experience: Four years of 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
- Experience working with the ACA.
- Experience working with Medicaid.
- Experience working with appeals.
LIMITATIONS ON SELECTION
LICENSES, REGISTRATIONS AND CERTIFICATIONS
Please make sure that you provide sufficient information on your application to show that you meet the qualifications for this recruitment. All information concerning your qualifications must be submitted by the closing date. We will not consider information submitted after this date. Successful candidates will be ranked as Best Qualified, Better Qualified, or Qualified and placed on the eligible (employment) list for at least one year.
The assessment may consist of a rating of your education, training, and experience related to the requirements of the position. It is important that you provide complete and accurate information on your application. Please report all experience and education that is related to this position.
The online application process is STRONGLY preferred. If you are unable to apply online, you may submit a paper application and resume to:
Maryland Health Benefit Exchange
Attn: Office of Human Resources
750 E. Pratt Street, 6th Floor
Baltimore, MD 21202
Resumes will NOT be accepted in lieu of completing the online or paper application. Applications must be received no later than the close of business on the closing date.
Appropriate accommodations for individuals with disabilities are available upon request by calling: MD TTY Relay Service at, 1-800-735-2258.
For questions regarding this recruitment, please email: email: email@example.com.
This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. Employers can only use E-Verify once you have accepted a job offer and completed the Form I-9. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration(SSA) so you can begin to resolve the issue before the employer can take any employment action against you.
As an equal opportunity employer, Maryland is committed to recruiting, retaining and promoting employees who are reflective of the State’s diversity. People with disabilities and bilingual candidates are encouraged to apply. We thank our Veterans for their service to our country.