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Fair Hearing Specialist

Date:  Aug 6, 2022
Location: 

Any city, AK, US, 99999

Req ID:  11708

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at HMS, a Gainwell Company carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary


HMS, a Gainwell Technologies Company


HMS is hiring Fair Hearing Specialists. The Fair Hearings Specialist assists Alaska Medicaid members in reviewing documentation and submitting a request for a Fair Hearing. This position also assists HMS and the client in review and preparation of documentation for review with the member and for presentation if a court hearing is required.

Your role in our mission

  • Develops a very high degree of knowledge of state and federal regulatory requirements and leverages it to comply with Medicaid programs and outreach operations.
  • Maintains thorough understanding of spend-down requirements within the assigned State and how that applies to program determination.
  • Conducts research to identify changes that would influence processes, procedures, or workflow.
  • Updates Service Line Manager on activities, issues, pending changes, and concerns.
  • Shares “best practices” advice/mentoring to the team members in support of operation policies and procedures.
  • Researches Fair Hearing law, processes, and procedures.
  • Gathers documentation and, if necessary, participates in Medicaid Fair Hearings.
  • Responds to case discontinuation and/or denials by determining the action required.
  • Performs other duties or projects as assigned by Manager.

What we’re looking for

  • Legal writing background and prehearing brief experience is beneficial with strong working knowledge of Medicaid required. Ability to interpret and apply agency, state, and federal rules, regulations, policies, and procedures in multiple states.
  • Strong conflict resolution skills and proficiency in research and complaint resolution. Excellent oral and written communication skills; ability to communicate to elderly individuals and State, County, and Federal governmental personnel. Strong organizational, analytical, critical thinking, and customer service skills.
  • Previous experience with screening for Medicaid eligibility required and preferred subject matter expertise and knowledge relevant to SSI and SSDI Federal requirements related to Medicaid eligibility.
  • Previous experience working with Medicare recipients required with excellent subject matter expertise and knowledge of all relevant Medicaid regulations and industry standards.
  • Strong ability to analyze and interpret governmental program criteria and Fair Hearing laws, and ability to interact and decipher information via telephonic or correspondence inquires. Ability to elicit information and perform and fulfill duties required for Fair Hearing briefs and Fair Hearing representation and exceptional attention to detail.

What you should expect in this role

Work-from-home (WFH); or Hybrid model including in-office and WFH days to be defined. For positions assigned to WFH, reliable high-speed internet connectivity is required.  Employees working-from-home may be required to report to the office, at times, to support work efforts.

 

The pay range for this position is $61,400.00 - $76,700.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at HMS, a Gainwell Company. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

 

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with HMS, a Gainwell Company, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about HMS, A Gainwell Technologies Company at our company website and visit our Careers site for all available job role openings.

 

HMS, a Gainwell Company is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

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