Appeals Division - This position is responsible for conducting appeal hearings to render decisions at the highest
administrative level in accordance with fair hearing principles. Decisions are subject to judicial review. Appeals
include eligibility and medical necessity issues for Medicaid, FAMIS, and other indigent health care programs
administered by DMAS.
The successful candidate must have considerable experience researching, interpreting, and applying state and federal regulations, and analyzing facts to reach logical, legally supportable conclusions. Requires considerable knowledge of administrative law and appeals procedures; considerable experience in analytical writing; considerable knowledge of Medicaid and other indigent health care programs, and of physical and mental health care needs of individuals. Must have experience interviewing individuals to obtain financial, legal, and/or medical information, experience independently managing a caseload within established time limits, and demonstrated ability to communicate clearly and effectively orally and in writing. Must be proficient using word processing software applications. Prefer degree in public administration, law, social work, nursing, mental health/mental retardation, and/or experience as an administrative hearing officer, attorney, eligibility worker/specialist, or the equivalent combination of education and experience.
REQUIRES VALID DRIVER'S LICENSE. REQUIRES OCCASIONAL TRAVEL
Virginia Jobs - 21 months ago