Fair Hearing Specialist

State of Vermont; Waterbury (VT); Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

12 paid holidays

Robust benefits package

Hybrid work environment

Job summary

State of Vermont is seeking a Fair Hearing Specialist (FHS) in the DVHA Health Access division to review and resolve disputes related to Medicaid or Vermont Health Connect eligibility determinations. The role offers a Monday–Friday schedule with a supportive hybrid work environment and a comprehensive benefits package.

Duties include detailed case reviews, policy tracking, correcting system errors, and coordinating with the Attorney General's office. Travel to court may be required as needed.

Qualifications

• Bachelor's degree AND one (1) or more years at or above a technical level role that includes research, customer service, review of healthcare services or similar field.
• OR Associate's degree AND three (3) or more years at or above a technical level role that includes research, customer service, review of healthcare services or similar field.
• OR High School diploma or equivalent AND five (5) or more years at or above a technical level role that includes research, customer service, review of healthcare services or similar field.

Responsibilities

• Conduct detailed review of cases brought by members who are in disagreement with a Medicaid or Vermont Health Connect healthcare eligibility determination.
• Track changes to policies and rules.
• Correct errors in the system and outreach customers to confirm disappointing decisions.
• Work closely with the Assistant Attorney General's office who represent the department in hearings.
• Manage conflicting priorities.
• Meet deadlines and provide superior customer service under difficult circumstances.
• Multi-task as needed.

Skills

Customer service

Research

Healthcare services review

Education

Bachelor's degree

Associate's degree

High School diploma

Job description

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Provide superior customer service to members who are in disagreement with Medicaid or Vermont Health Connect health eligibility determinations. The Health Care Appeals unit at the Department of Vermont Health Access (DVHA) is looking for a Fair Hearing Specialist (FHS) to fill this rewarding role. Have the work/life balance you need with a Monday-Friday schedule and a supportive hybrid work environment. 12 paid state holidays, in addition to a robust benefits package.

The Fair Hearing Specialist position has the following responsibilities:

• Conduct detailed review of cases brought by members who are in disagreement with a Medicaid or Vermont Health Connect healthcare eligibility determination.
• Track changes to policies and rules.
• Correct errors in the system and in some instances outreach customers to confirm disappointing decisions.
• work closely with the Assistant Attorney General's office, who represent the department in hearings.
• Manage conflicting priorities.
• Meet deadlines and provide superior customer service under difficult circumstances.
• Multi-task as needed.

Mission: The Department of Vermont Health Access (DVHA)'s mission is to improve Vermonters' health and well-being by providing access to high-quality, cost-effective health care. We have identified three priorities that support our mission: Advancing value-based payments, modernizing information technology infrastructure, and operational performance improvement. Our department commits to executing our responsibilities and priorities while adhering to three core values: Transparency, Integrity and Service.

Diversity, Equity, and Inclusion: As part of our values of transparency, integrity, and service, we are committed to supporting diversity, equity, inclusion, and accessibility as part of our person-centered culture. We actively celebrate our colleagues' and future colleagues' different abilities, racial identity, sexual orientation, ethnicity, age, and gender. Everyone is welcome and supported here.

Our State: Vermont is a "small but mighty" state. We are ranked as one of the top 10 states to raise a family in 2022. We are nationwide leaders for progressive social and educational policies. We are in Northern New England, 1.5 hours from Montreal and 3.5 hours from Boston. We have beautiful Lake Champlain, the Green Mountains, and year-round outdoor activities.

AHS BACKGROUND CHECKS: Candidates must pass any level of background investigation applicable to the position. In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.

Duties are performed in a standard office setting. Some travel may be necessary, for which private transportation must be available. Stressful interaction with upset or emotional clients may occur. Staff workload may frequently be heavy. Work outside of typical business hours may be expected and incumbents might be required to appear in court, representing the State of Vermont.

Minimum Qualifications

Bachelor's degree AND one (1) or more years at or above a technical level role that includes research, customer service, review of healthcare services or similar field

OR

Associate's degree AND three (3) or more years at or above a technical level role that includes research, customer service, review of healthcare services or similar field.

OR

High School diploma or equivalent AND five (5) or more years at or above a technical level role that includes research, customer service, review of healthcare services or similar field.

Total Compensation

As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits that are worth about 30% of your total compensation, including:

• 80% State paid medical premium and a dental plan at no cost for employees and their families
• Work/Life balance: 12 paid holidays each year and a generous leave plan
• State Paid Family and Medical Leave Insurance (FMLI)
• Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
• Tuition Reimbursement
• Flexible spending healthcare and childcare reimbursement accounts
• Low cost group life insurance
• Incentive-based Wellness Program
• Qualified Employer for Public Service Student Loan Forgiveness Program

The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State’s employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.