Administrative Hearing Specialist (AHS/DLS) - Internal

State of Washington; Deutschland; Hybrid; EUR 56.000 - 77.000; Vollzeit

Zusammenfassung

Washington State Health Care Authority seeks an Administrative Hearing Specialist (AHS/DLS) to represent the agency in WA Apple Health MAGI eligibility hearings. The role handles a caseload from intake to resolution, coordinating with OAH, HBE, and other state agencies, and prepares hearing materials and exhibits.

The position may telework but requires onsite presence in Olympia as needed. Strong data analysis, familiarity with ACES/HPF/Barcode, and a commitment to equity are essential.

Qualifikationen

• Bachelor's or higher and relevant experience in public assistance determinations.
• Two years or more of eligibility determinations experience; MAGI Medicaid knowledge is preferred.
• Ability to analyze case histories and verify data across systems.

Aufgaben

• Represent agency interests in Administrative Hearings regarding eligibility.
• Develop hearing packets with agency position and supporting exhibits.
• Coordinate with OAH, HBE, and other state agencies for appeals.
• Manage a hearings caseload and monitor deadlines and docket calendar.
• Prepare analytical statistical reports using Power BI and Office tools.
• File motions and respond to appellant motions with designated exhibits.

Kenntnisse

Eligibility determinations experience

Public assistance programs

Analytical reasoning

Advocacy during hearings

Ausbildung

Bachelor's degree

Associate degree

Tools

ACES

HPF

Barcode/DMS

Jobbeschreibung

Description

Administrative Hearing Specialist (AHS/DLS) - Internal

71028690

This opportunity is internal and available to current HCA employees only.

The Administrative Hearings Specialist represents the agency in hearings related to Washington Apple Health eligibility disputes. This role serves as the eligibility subject matter expert, hearing representative, and develops hearing packets that include a persuasive summary of the agency’s position and supporting exhibits. The position manages an active caseload from intake through resolution, coordinating with the Office of Administrative Hearings, the Health Benefit Exchange, and other State agencies to ensure timely and accurate adjudication.

All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.

About the division:

The Division of Legal Services (DLS) provides support to the entire agency to mitigate risks, comply with changing laws, and assist the agency in accomplishing its strategic and tactical goals. DLS' mission is to "deliver legal and specialized professional support so HCA can provide high-quality health care through innovative health policies and purchasing strategies." Its vision is to "be a model of excellent customer service and efficiency in the delivery of legal and specialized professional services." In addition to the agency-wide values, DLS values include excellence, dependability, customer focus, and integrity.

About the position:

This position supports the HCA mission to provide access to medical care for all eligible Washington citizens. This position serves as an Administrative Hearings Specialist for the Washington Apple Health (WAH) Modified Adjusted Gross Income (MAGI) programs.

This position is eligible to telework but is occasionally required to report onsite to meet business needs. The default assigned work location of all Health Care Authority (HCA) positions – both onsite and telework eligible positions – is within the State of Washington. This position reports to Olympia, WA. Frequency of onsite work will vary based on business and operational needs. All agency employees are required to report on-site in Olympia on their first and last days of employment to pick up and return state‑issued equipment, regardless of telework status or location.

Duties

Some of what you will do:

• Represent the agency’s interests in Administrative Hearings (AH) regarding eligibility and other issues related to WAH. Represents the agency’s interests by providing argument as the eligibility subject matter expert during the hearing process, demonstrating how the rules support the agency’s decision.
• Pursue possible resolution prior to hearing. Research and analyze case history to include all client documents, income verification systems, and case notes to determine if the appropriate case actions were initially taken. Reprocesses cases if necessary to obtain correct eligibility results.
• Develop hearing packets for administrative proceedings to include an outline of the agency’s position in a report summarizing the facts and the agency’s position on the case. Provides exhibits to support the agency’s actions, and provides WACs, rules, and policy guidelines to further substantiate the eligibility determination.
• Files motions including motions to dismiss and motions for summary judgment when required. Determines and files the appropriate response to the appellant’s motions and exhibits.
• Coordinates with the Office of Administrative Hearings, the Washington Health Benefit Exchange (HBE) and representatives from other state agencies such as DSHS Community Services Office, Home and Community Services, and Office of Administrative Hearings to ensure a seamless appeals process.
• Manages a hearings caseload. Uses Barcode to triage and assign hearing requests and documents. Monitors the hearing process through JAHCS to ensure all actions are taken timely and deadlines are met. Maintains the AH docket calendar. Works with supervisor and other AHSs to ensure full coverage of the hearing schedule.
• Tracks case details and resolutions in JAHCS to capture accurate case data.
• Utilize multiple inter-dependent electronic systems including but not limited to the Health Plan Finder (HPF), Automated Client Eligibility System (ACES), ProviderOne, Microsoft Office, SOLQ, Barcode, Web Ax, DOH, Employment Security Department (ESD), Right Fax, SharePoint, and JAHCS.
• Develops and files response/petitions that support the agency’s position with the Board of Appeals.
• Verifies accuracy of data and prepares substantive analytical statistical reports for the Section Manager utilizing Power BI, Microsoft Office Suite (including Word, Access, Excel, etc.), and HCA applications including but not limited to the Hearings and Appeals Management System and the Joint Administrative Hearings Case System paying high attention to detail.
• Represents the agency’s interests in AH regarding Medical/Dental/Transportation and Equipment (MDTE) disputes, including pre-hearing resolution efforts and filing hearing packets and exhibits.

Qualifications

Required qualifications:

Qualifying candidates will meet one of the following criteria options:

Option 1:

Bachelor's degree and two (2) years’ experience conducting eligibility determinations for public assistance programs.

Option 2:

Associate degree and four (4) years’ experience conducting eligibility determinations for public assistance programs.

Option 3:

Six (6) years’ experience conducting eligibility determinations for public assistance programs.

Required competencies:

• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.

Preferred qualifications:

• Demonstrated experience using programs such as ACES, HPF, Barcode/DMS
• Determining eligibility for MAGI Medicaid/Medical programs.

Supplemental Information

About HCA:
Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.
What we have to offer:

• Meaningful work with friendly co-workers who care about those we serve Voices of HCA
• A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values
• A healthy work/life balance, including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit package WA State Government Benefits
• A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.
• And free parking!

Notes:

Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.

HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA’s mission. Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women, racial and ethnic minorities, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them, please contact us at [e-mail] Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Lisa Fleming at [phone] or [e-mail]

The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.

E-Verify® is a registered trademark of the U.S. Department of Homeland Security.

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