Medical Hearing Officer

Dept of Med Assistance Svcs; Richmond (VA); On-site; USD 86,000 - 91,000; Full time

Job summary

The Department of Medical Assistance Services (DMAS) in Virginia invites applications for the Medical Hearing Officer within the Appeals Division. The role conducts client medical appeal hearings, reviews case documents, and renders decisions consistent with fair hearing principles and timeframes.

Ideal candidates will have strong legal analysis, research skills, and experience managing caseloads; in‑person hearings are required by business needs, with optional telework subject to policy.

Qualifications

• Experience independently managing a caseload to meet established time frames.
• Extensive experience applying rules to facts to reach legally sound conclusions.
• Knowledge of administrative law and appeals procedures.
• Extensive knowledge of legal research methodologies, including computerized legal research.
• Extensive experience with technology, including MS Office.
• Extensive experience interpreting, applying, and analyzing federal and state complex laws, regulations, policies, or case law.
• Experience meeting deadlines.
• Experience with internal and external stakeholders.
• Extensive experience in legal analysis and legal writing.

Responsibilities

• Review appeal requests, case documents, and evidence to prepare for and conduct client medical appeal hearings.
• Render written appeal decisions at the highest administrative level in timeframes.
• Apply laws, rules, and regulations to independently render decisions based on findings and law; manage a caseload.
• Provide excellent customer service and ensure due process.
• In-office hearings are required as part of business needs.

Skills

Caseload management

Legal reasoning

Legal research

MS Office

Regulatory interpretation

Deadline driven

Stakeholder management

Legal writing

Education

Virginia State Bar admission

Tools

MS Office

Electronic legal research

Job description

Title: Medical Hearing Officer

State Role Title: Hearing Legal Servcs Offcr II

Hiring Range: $85,972 - $90,761

Pay Band: 5

Agency: Dept of Med Assistance Svcs

Location: Dept of Medical Asst Services

Agency Website: www.dmas.virginia.gov

Recruitment Type: General Public - G

Job Duties

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Medical Hearing Officer in the Appeals Division.

• 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.

Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org/

The Department of Medical Assistance Services (DMAS) is working to improve the health and well‑being of Virginians through access to high‑quality health care coverage.

DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability.

At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Minimum Qualifications

• Experience independently managing a caseload to meet established time frames.
• Considerable work‑related experience applying rules to facts to reach logical, legally supportable conclusions.
• 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.
• Experience in meeting deadlines.
• Experience with internal/external stakeholders.
• Considerable experience in legal analysis and legal writing.

Additional Considerations

• Admission to the Virginia State Bar in good standing.
• Experience drafting appeal decisions.

Special Instructions

The Virginia Department of Medical Assistance Services (DMAS) does not offer employment‑based Sponsorship. Selected candidates will have their work authorization completed using the E‑Verify Program.

The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth’s Department of Human Resource Management Policy 1.61 Teleworking. This position could be expected to work in the office as driven by business needs.

Telework arrangements are a privilege and may be rescinded at any time based on performance and/or business need. The agency reserves the right to modify or terminate a telework arrangement, provided that reasonable notice is given to the employee.

This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references.

The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce.

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service‑Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155

The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.

Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.

Contact Information

Name: DMAS Talent Acquisition

Phone: 804 - 225 - 4407

Email: [e-mail]

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.