Eligibility Hearing Officer

DHRM•Richmond, VA

9d•Hybrid

About The Position

The Department of Medical Assistance Services (DMAS) is offering a competitive opportunity to serve as the Eligibility Hearing Officer in the Appeals Division. This role involves reviewing appeal requests, case documents, and evidence to prepare for and conduct client eligibility appeal hearings. The officer will render written appeal decisions at the highest administrative level, adhering to fair hearing principles and established timeframes. This position requires applying knowledge of laws, rules, and regulations, administrative procedures, due process standards, and legal research methods to make legally sound and defensible recommendations and judgments. The role also includes independently managing a caseload to ensure timely compliance with deadlines, providing excellent customer service, ensuring appellants receive full due process, supporting a collaborative work environment, and producing a quality work product. The position has in-office requirements, including in-person hearings. DMAS is dedicated to improving the health and well-being of Virginians through access to high-quality health care coverage and seeks talented individuals who align with the agency's mission and core values: service, collaboration, trust, problem-solving, and adaptability.

Requirements

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.

Nice To Haves

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

Responsibilities

Review appeal requests, case documents, and other appropriate evidence to prepare for and conduct client eligibility 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.
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.
Produce a quality work product.