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ADMINISTRATOR I

Appeals and Grievance Administrator

Recruitment #21-002586-0093

GRADE

16

LOCATION OF POSITION

At the time of this job announcement MHBE is adhering to a hybrid work schedule. Work for this position will be completed at a remote home location and at our office 750. E. Pratt St 6th Floor Baltimore, MD 21202. The essential functions of this position will require travel to hearing locations across Maryland once in-person hearings resume (estimated 1 - 2 days per week).

Main Purpose of Job

The main purpose of this position is to provide support to the Appeals and Grievances Manager by researching grievance and appeals histories, organizing information for review, preparing summaries for hearings and presenting to A&G leadership to ensure timely decision making, accurate reporting and appropriate outcomes. The position reviews Medicaid eligibility, individual market eligibility appeals, mandate exemption appeals, employer eligibility appeals from the individual market, Maryland Health Connection for Small Business employer and employee eligibility appeals, as well as appeals of enrollment periods, including special enrollment periods. This position acts as a policy specialist for Medicaid and the Affordable Care Act, and assists with trainings for other departments within Maryland State agencies. This position will prepare IRS Tax Subsidy summaries for the Assisted Attorney General’s offices for the Maryland Health Benefit Exchange, and will testify as an expert witness during the administrative hearing process.

POSITION DUTIES

  • 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.

MINIMUM QUALIFICATIONS

Education: A Bachelor's degree from an accredited college or university.

Experience: Four years of experience in administrative staff or professional work.

Notes:

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

This recruitment is limited to current MHBE employees only.

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in this classification may be assigned duties which 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.

SELECTION PROCESS

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.

EXAMINATION PROCESS

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.

BENEFITS

FURTHER INSTRUCTIONS

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: jasciel.stamp@maryland.gov.

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.