Fair Hearing Eligibility Specialist

Arizona Department of Administration • Phoenix, AZ

1d • Remote

About The Position

AHCCCS Fair Hearing Eligibility Specialists, (BES Advanced), are responsible for
reviewing appealed adverse actions, completing pre-hearing discussions, fair
hearing packets and representing the agency at fair hearing. Research and
interpret Federal and State laws, rules, related hearings or court decisions;
ensures that appropriate authorities are included in the hearing packet;
explains eligibility criteria to customers; works with the eligibility offices
to prepare for fair hearings and assists in resolving matters prior to being set
to calendar. They also process appropriate actions, to include initial and
renewal determinations, in the eligibility system. They prepare motions,
objections to motions and rehearing requests. Maintains the OMS Hearing Calendar
and May be required to participate as part of a continuous process improvement
team member or assist with a special project.

The State of Arizona strives for a work culture that affords employees
flexibility, autonomy, and trust. Across our many agencies, boards, and
commissions, many State employees participate in the State’s Remote Work Program
and are able to work remotely in their homes, in offices, and in hoteling
spaces. All work, including remote work, should be performed within Arizona
unless an exception is properly authorized in advance.

Requirements

• Medicare and Medicaid Laws
• State and Federal rules and regulations
• ALTCS and MA-SP financial eligibility policies and procedures
• Budget calculations based upon the program to which the recipient is linked
• Written and verbal communication
• Conducting research
• Interviewing techniques
• Investigative interviewing
• Interpersonal relationships; mathematical calculations.
• Organize and prioritize tasks
• Communicate both verbally and in writing
• Effectively document observations and decisions
• Accurately calculate mathematical equations
• Correctly interpret and apply current laws, rules and regulations
• Efficiently assist family members and other agencies
• Use numerous computer data bases and programs to include ACE, HEAplus, PMMIS, Fortis, AZTEC and Rightfax
• Use logic, problem solving techniques, and analytical skills
• Must have a high school diploma or General Equivalency Diploma (G.E.D) and 3 years of customer service experience.
• Arizona Driver's License

Nice To Haves

• Two years of work experience equivalent to a Benefit & Eligibility Specialist or Program Services Evaluator (e.g., interviews and determines eligibility for public assistance benefits).

Responsibilities

• Reviewing adverse actions that are being appealed; investigating each case to identify if the decision is correct and making every attempt to resolve the eligibility problem to avoid a fair hearing; completing pre-hearing discussions and fair hearing packets; presenting of packets to the Office of Administrative Hearings (OAH) and to the Complainant within specified timeframes.
• Representing the agency at fair hearing and present explanation of agency's action and all relevant evidence and testimony; taking appropriate actions in the eligibility system regarding based on hearing decision.
• Assists in the maintenance and monitoring of the OMS Hearing Calendar; making initial and renewal eligibility determinations for MA-SP, Medicaid and AL TCS; entering eligibility data into the computer systems and information into hearing log.
• Accurately interpreting and application of MA-SP, Medicaid, and ALTCS laws, rules, regulations required to determine eligibility.
• Preparing motions necessary for vacates, continuances, and consolidations; preparing objections to motions and to rehearing requests; special project assignments.

Benefits

• 10 paid holidays per year
• Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
• Other Leaves - Bereavement, civic duty, and military.
• A top-ranked retirement program with lifetime pension benefits
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED