Medicaid Fair Hearing Operations Specialist

Biogensys; Trenton (NJ); On-site; USD 45,000 - 65,000; Full time

Job summary

Biogensys in Hamilton, NJ is seeking a Program Support Specialist to assist the Medicaid Fair Hearing Unit with appeals processing and regulatory compliance. The role involves administrative duties, data entry, and coordination with counties and MCOs to ensure timely hearings and accurate reporting.

Under supervision, you will help triage cases, manage case files, and support the CMS compliance plan, with a focus on quality data, efficient workflow, and timely closures within the agency systems.

Qualifications

• Ability to analyze information and prepare reports.
• Proficiency with Microsoft Office Suite.
• Strong data entry and recordkeeping skills.
• Excellent written and verbal English communication.

Responsibilities

• Analyze incoming mail, faxes, and requests to identify contested issues.
• Input and maintain case information in agency databases.
• Review and manage Fair Hearing cases from receipt to disposition.
• Prepare and transmit case files to OAL for scheduling.
• Track cases through lifecycle to ensure timely processing and closure.
• Coordinate informal resolution with CWAs, MCOs, providers and petitioners.
• Generate monthly reports on outstanding, accepted, and pending hearings.

Skills

Data entry

MS Office

Analytical thinking

English communication

Job description

Biogensys in Hamilton, NJ is seeking a Program Support Specialist to assist the Medicaid Fair Hearing Unit with appeals processing and regulatory compliance. The role involves administrative duties, data entry, and coordination with counties and MCOs to ensure timely hearings and accurate reporting.

Under supervision, you will help triage cases, manage case files, and support the CMS compliance plan, with a focus on quality data, efficient workflow, and timely closures within the agency systems.