Title: Hearing and Legal Services Officer
Location: Richmond, VA 23219
Pay Rate: $50.00/Hour on W2 without benefits
Duration: 12+ months
Shift Timing (Day/ Evening/ Night): Day
Job Description:
- Review and decide appeals:
- Go through appeal requests and case documents to prepare for and conduct hearings. Write clear decisions based on facts and legal rules, following fair hearing standards and deadlines.
- Use legal knowledge:
- Apply laws, rules, and procedures to make fair and accurate decisions. Do legal research, analyze evidence, and manage your cases independently to meet timelines.
- Ensure fairness and respect:
- Provide respectful and professional service to everyone. Make sure each person gets a fair hearing and help maintain a positive team environment.
Reporting:
- This role reports to the Eligibility Cases Manager.
Required knowledge, skills, and abilities (KSAs):
- Experience in a fast-paced, deadline-driven environment
- Experience independently managing a caseload to meet established time frames
- Experience with internal and external stakeholders
- Knowledge of administrative law and/or appeals procedures
- Considerable experience applying rules to facts to reach logical, legally supportable conclusions
- Considerable experience interpreting, applying, and analyzing federal and state complex laws, regulations, policies, or case law
- Considerable experience in legal analysis and legal writing
- Considerable knowledge of legal research methodologies, including computerized legal research
- Considerable experience with technology, including MS Office
- Admission to the Virginia State Bar in good standing, or eligible for admission to the Virginia State Bar within six months from the start date in the position.
Additional Considerations:
- Experience drafting appeal decisions.
- What work actions and/or decisions are made without prior approval? To what extent is the incumbent required to seek advice and guidance from the supervisor?
- Independently manage issues and risks proactively and exercise strong business judgment in escalating matters to the Eligibility Cases Manager.
- Independently research state and federal laws, regulations, and policy.
Role & Responsibilities:
- Conduct thorough hearing preparation and hearings for all Medicaid appeal cases assigned to inventory.
- Follow all rules and procedures set by the Appeals Division
- Use the Appeals Information Management System (AIMS) effectively to track cases, complete tasks, add notes, and manage appeal activities
- Keep case records accurate and up to date by regularly updating files and logging actions in AIMS
- Handle your own set of cases and complete hearing prep work on time
- Research legal issues thoroughly and stay informed about current laws, policies, and regulations that affect appeal decisions
- Lead client eligibility appeal hearings using proper legal procedures, ensuring fairness and due process
- Share case-related data and performance metrics with the Eligibility Cases Manager when requested.
- Draft and issue legally supportable state fair hearing decisions in accordance with all deadlines.
- Follow all established procedures of the Appeals Division
- Use the Appeals Information Management System (AIMS) confidently to:
- Attach hearing recordings
- Upload final decisions and exhibit packets
- Handle decision submissions, including resubmission requests
- Ensure decisions are released on time so they can be mailed by the print vendor before the deadline
- Apply laws, rules, regulations, and policies to make fair and well-reasoned written decisions based on facts and legal conclusions
- Submit decisions to the Quality Assurance Team within required timeframes, focusing on meeting federal deadlines
- Make sure all decisions are released in AIMS before their due dates
- Share performance data and case metrics with the Eligibility Cases Manager when requested
- Collaborate with Appeals Division team members.
- Build productive working relationships with peers and work collaboratively to manage the flow of appeals
- Assist with increased workload volume across teams, as requested
- Complete assigned tasks and projects in a timely manner
- Communicate effectively both orally and in writing with various staff members as it relates to assigned tasks and projects
- Assist with training, as requested, to ensure continuity of operations
- Immediately escalate issues between peers to management to ensure that an effective resolution can be reached in a timely manner
Special Assignments:
- Special assignments are made at the request of the Eligibility Cases Manager, General Operations Manager, and Division Director.
- Satisfactory completion of assignments within timeframes established by the Eligibility Cases Manager, General Operations Manager, and Division Director.
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