ADMINISTRATOR I

16

Baltimore City, Maryland

The main purpose of this position is to provide support to the Appeals and Grievances Manager by researching grievance and appeals histories, organizing information for review, preparing summaries for hearings, and presenting to A&G leadership to ensure timely decision making, accurate reporting and appropriate outcomes. The position reviews Medicaid eligibility, individual market eligibility appeals, mandate exemption appeals, employer eligibility appeals from the individual market, and appeals of enrollment periods, including special enrollment periods. This position acts as a policy specialist for Medicaid and the Affordable Care Act and assists with trainings for other departments within Maryland State agencies. This position will correct IRS Tax Subsidy summaries and will testify and an expert witness during the administrative hearing process.

• 10% - Conduct research and adjudicate a caseload of appeals of individuals, business and/or providers. Interview applicants and representatives associated with investigation.

• 10%- Analyze pertinent facts against appropriate regulatory and policy provisions and develop written recommendations to management for the appeal decision.

• 10%- Develop the supporting case file, in consultation with legal staff, for appeals that escalate to a review by an Administrative Law Judge from the Office of Administrative Hearings. Provide support for adjudication of appeals and hearings as required.

• 10%- Prepare written reports analyzing alternatives and consequences, specifying findings and recommendations for management action, strategy, policy determinations and process changes.

• 10%- Provide extensive interpretation of state and federal eligibility statutes, regulations, policies and guidelines to the administrative vendor, enrolled subscribers and the general public.

• 10%- Conduct review of eligibility appeal requests and supporting documentation, coordinate data collection with appellants perform general case management for appeals.

• 10%- Prepare and present routine appeals cases at OAH.

• 5%- Assist OAG, as needed, in the preparation of complex cases for presentation at OAH.

• 10%- Perform Case Reviews appeals and special projects for Maryland Health Benefit Exchange.

• 5%- Acts as a liaison between local agencies.

• 10%- Track and Update the MHBE Escalated Cases Tracker for Appeals and Constituent Services. Update and monitor Salesforce for Carrier response and file requests.

Education: Graduation from an accredited high school or possession of a high school equivalency certificate.

Experience: Four years of administrative staff or professional work.

Notes:

1. Candidates may substitute 30 college credit hours from an accredited college or university for each year up to four years of the required experience.

2. Candidates may substitute the possession of a Bachelor's degree from an accredited college or university for the required experience.

3. Candidates may substitute the possession of a Master's degree from an accredited college or university for the required experience.

4. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer involving staff work related to the administration of rules, regulations, policy, procedures and processes, or overseeing or coordinating unit operations or functioning as a staff assistant to a higher ranking commissioned officer on a year-for- year basis for the required experience.

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator's license valid in the State of Maryland.

The online application process is STRONGLY preferred. If you are unable to apply online, you may mail a paper application and supplemental questionnaire to: 750 East Pratt Street, 6th Floor, Baltimore MD, 21202.

Applicants must meet all minimum (and selective) qualifications to be considered, and to appear on the list of people eligible for hire. Please read all requirements before applying.

Please make sure that you provide sufficient information on your application to show that you meet the qualifications for this recruitment. All information concerning your qualifications must be submitted by the closing date. We will not consider information submitted after this date. Successful candidates will be ranked as Best Qualified, Better Qualified, or Qualified and placed on the eligible (employment) list for at least one year.

The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

Please make sure that you provide sufficient information on your application to show that you meet the qualifications for this recruitment.

All information concerning your qualifications must be submitted by the closing date. We will not consider information submitted after this date.

Successful candidates will be ranked as Best Qualified, Better Qualified, or Qualified and placed on the eligible (employment) list for at least one year.

Candidates selected for interview may be required to provide a writing sample for review and evaluation as part of the competitive recruitment process.

STATE OF MARYLAND BENEFITS

Resumes will not be accepted in lieu of completing the online or paper application.

Applications must be received no later than the close of business on the closing date.

As an equal opportunity employer, Maryland is committed to recruiting, retaining, and promoting employees who are reflective of the State's diversity.

People with disabilities and bilingual candidates are encouraged to apply.

We thank you our veterans for their service to our country and encourage them to apply.

Appropriate accommodations for individuals with disabilities are available upon request by calling MD TTY Relay Service.

This employer participates in E-Verify and will provide the Federal government with your Form 1-9 information to confirm that you are authorized to work in the U.S.

Employers can only use E-Verify once you have accepted a job offer and completed the Form 1-9.

If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact the Department of Homeland Security (OHS) or Social Security Administration (SSA) so you can begin to resolve the issues before the employer can take any employment action against you.

For education obtained outside the U.S., a copy of the equivalent American education as determined by a foreign credential evaluation service must be provided prior to hire.

For questions regarding this recruitment, please contact the DBM Recruitment and Examination Division at Application.Help@maryland.gov or 410-767-4850, MD TTY Relay Service 1-800-735-2258.