Skip to Main Content

ADMINISTRATOR I

Appeals and Grievance Administrator

Recruitment #24-002586-0017

Go Back View Benefits

GRADE

16

LOCATION OF POSITION

750 E. Pratt St., 6 Fl., Baltimore, MD 21202

Main Purpose of Job

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, Small Business Health Options Program (SHOP) employer eligibility appeals, and SHOP employee eligibility appeals 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 prepare IRS Tax Subsidy summaries for the Assisted Attorney General’s offices for the Maryland Health Benefit Exchange and will testify and an expert witness during the administrative hearing process.

POSITION DUTIES

  • This position will prepare IRS Tax Subsidy summaries for the Assistant Attorney General’s offices for the Maryland Health Benefit Exchange, and will testify and an expert witness during the administrative hearing process.
  • Conduct research and adjudicate a caseload of appeals of individuals, business and/or providers.
  • Interview applicants and representatives associated with investigation.
  • 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.
  • Conduct review of eligibility appeal requests and supporting documentation, coordinate data collection with appellants perform general case management for appeals.
    • Prepare and present appeals cases at OAH.

MINIMUM QUALIFICATIONS

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.

DESIRED OR PREFERRED QUALIFICATIONS

  • Experience working with the ACA.
  • Experience working with Medicaid.
  • Experience working with appeals.

LIMITATIONS ON SELECTION

This recruitment is limited to Maryland Health Benefit Exchange employees only.

LICENSES, REGISTRATIONS AND CERTIFICATIONS

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.

EXAMINATION PROCESS

Applicants who meet the minimum qualifications will be evaluated.  The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position.  Therefore, it is essential that you provide complete and accurate information on your application.  Please report all related education, experience, dates and hours of work.  For education obtained outside the U.S., a copy of the equivalent American education as determined by a foreign credential evaluation service may be required prior to hire.  All information concerning your qualifications must be submitted by the closing date.  We will not consider information submitted after this date.  Applicants certified to list will be placed in the Best Qualified, Better Qualified, or Qualified category and receive eligibility for a period of one (1) year.  Eligibility may be extended beyond one (1) year period.

BENEFITS

STATE OF MARYLAND BENEFITS

As an employee of the State of Maryland, you will have access to outstanding benefi ts, including: health insurance, dental, and vision plans off ered at a low cost. 

Click on this link for more details: 


Personal Leave - new State employees are awarded six (6) personnel days annually (prorated based on start date) Annual Leave - ten (10) days of accumulated annual leave per year Sick Leave - fi ft een (15) days of accumulated sick leave per year Parental Leave - up to sixty (60) days of paid parental leave upon the birth or adopti on of a child Holidays - State employees also celebrate at least twelve (12) holidays per year Pension - State employees earn credit towards a reti rement pension 401(k) – State employees can contribute to a supplemental Reti rement Plan

 

FURTHER INSTRUCTIONS

The online application process is STRONGLY preferred. If you are unable to apply online, you may submit a paper application and resume:

via email: tisha.payne@maryland.gov via mail:

MHBE Office of Human Resources 750 E. Pratt St, 6th Floor Baltimore, MD 21202 

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. 

Appropriate accommodations for individuals with disabilities are available upon request by calling MDTTY Relay Service. TTY Users: call via Maryland Relay. 

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 our Veterans for their service to our country and encourage them to apply. 

This employer participates in E-Verify and will provide the federal government with your Form I-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 I-9. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you writt en instructions and an opportunity to contact the Department of Homeland Security (DHS) or Social Security Administrati on (SSA) so you can begin to resolve the issues before the employer can take any employment acti on against you.



Powered by JobAps