Medical Hearing Officer

DHRM•Richmond, VA

2d•Hybrid

About The Position

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. Multiple positions will be filled from this job posting. Job responsibilities will include, but are not limited to: 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.

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 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.
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.
Conduct in-person hearings.