Medical Appeals Hearing Officer

DHRM; Richmond (VA); On-site; USD 86,000 - 91,000; Full time

Job summary

The Department of Medical Assistance Services in Virginia seeks a Medical Hearing Officer to review appeal requests, examine case documents and evidence, and conduct client hearings in accordance with fair hearing principles.

You will render written decisions at the highest administrative level, apply federal and state laws and regulations, manage a substantial caseload, and ensure timely, well-reasoned outcomes while delivering respectful, high-quality service to all appellants.

Qualifications

• Experience independently managing a caseload to meet established time frames.
• Knowledge of administrative law and / or appeals procedures.
• Considerable knowledge of legal research methodologies, including computerized legal research.
• Considerable experience with technology, including MS Office.
• Considerable experience interpreting, applying, and analyzing federal and state complex laws, regulations, policies, or case law.

Responsibilities

• Review appeal requests, case documents, and other appropriate evidence to prepare for and conduct client medical appeal hearings.
• Render written appeal decisions at the highest administrative level in accordance with fair hearing principles and within established timeframes.
• Apply knowledge of laws, rules, and regulations in the decision process to independently render decisions based on findings of fact and conclusions of law; apply knowledge of administrative procedures for conducting hearings, due process standards, and legal research methods; conduct legal research; engage in thorough, accurate, and objective analysis and evaluation of facts, evidence, and law in order to make legally sound and defensible recommendations and judgments; and independently manage a caseload to ensure timely compliance with deadlines.
• Provide excellent customer service, treating everyone who interacts with the Division with respect and dignity; ensure every appellant receives full due process; support a collaborative and positive work environment; and produce a quality work product.
• The business needs for this position have in office requirements to include but are not limited to in-person hearings.

Skills

Caseload management

Legal research

Administrative law

Legal writing

MS Office

Regulatory analysis

Deadlines

Stakeholder management

Education

Virginia State Bar admission

Job description

The Department of Medical Assistance Services in Virginia seeks a Medical Hearing Officer to review appeal requests, examine case documents and evidence, and conduct client hearings in accordance with fair hearing principles.

You will render written decisions at the highest administrative level, apply federal and state laws and regulations, manage a substantial caseload, and ensure timely, well-reasoned outcomes while delivering respectful, high-quality service to all appellants.