Description

Key Responsibilities

• Analyze incoming mail, faxes, correspondence, and appeal requests to determine contested issues
• Input and maintain case information in agency databases and information systems
• Review, process, and manage Fair Hearing cases from receipt through final disposition
• Prepare, organize, and transmit Fair Hearing case files to the Office of Administrative Law (OAL)
• Track contested cases, monitor status, and ensure timely processing, resolution, and closure
• Coordinate informal resolution efforts with County Welfare Agencies, Managed Care Organizations, and other stakeholders
• Generate monthly reports on outstanding, accepted, declined, resolved, and pending Fair Hearing requests
• Research applicable federal and State laws, regulations, and policies supporting the Fair Hearing process
• Scan, organize, and maintain electronic and hard-copy case files in compliance with recordkeeping requirements
• Monitor and reconcile pending appeals and conduct follow-up with internal and external stakeholders

Required Skills

• Proficiency in Microsoft Office Suite
• Data entry and customer service experience
• Strong analytical and problem-solving skills
• Ability to review, interpret, and evaluate data and legal/regulatory information
• Ability to prepare accurate and informative reports
• Ability to maintain accurate records and files
• Effective written and verbal communication skills in English

Preferred Skills

• Experience with case management or legal databases (e.g., LRL Oracle)
• Background in Medicaid, Fair Hearing, or state agency administrative functions
• Familiarity with federal CMS regulations and compliance requirements

Key Skills

Education

Any Gradute