ADMINISTRATIVE OFFICER III

15

750 E. Pratt St., 16th Fl. Baltimore, MD 21202

This position facilitates the eligibility determination process for Exchange services. The position determines client eligibility across multiple programs and quality assures evaluation of applications and determinations of eligibility. The position also provides information and support to the eligibility appeals process. The position serves as a subject matter expert providing consultation and technical assistance in the interpretation and application of federal and state laws and regulations regarding individual eligibility determinations and interfacing/overlapping areas within the Medicaid Program.

Conduct research and adjudicate a caseload of appeals of individuals, business and/or providers.

Analyze pertinent facts against appropriate regulatory and policy provisions which results in a written recommendations to management for the appeal decision.

Develop supporting case files, 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. Prepare written reports analyzing alternatives and consequences, specifying findings and recommendations for management actions, strategies, policy determinations and process changes.

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

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

 Prepare and present routine appeals cases at OAH.  Assist OAG, as needed, in the preparation of complex cases for presentations at OAH.  

 Perform Case Reviews for Maryland Health Benefit Exchange. Acts as a liaison between local agencies. Leads and Trains Staff.

Education: Possession of a bachelor's degree from an accredited four-year college or university.

Experience: Three years experience in administrative or professional work.

Notes:

1. Candidates may substitute additional experience in administrative staff or professional work on a year-for-year basis for the required education.

 2. Candidates may substitute additional graduate level education at an accredited college or university at the rate of 30 semester credit hours for each year of the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer involving staff work that included the regular independent judgment and analysis in applying and interpreting complex administrative plans, policies, rules or regulations or analysis of operational programs or procedures with recommendations for improvement on a year to year basis for the required education and experience.  

1.Experience in determining Medicaid eligibility, some knowledge of the Affordable Care Act/ACA.

2. Experience in preparing and representing the agency in Administrative Hearings.

3. Familiarity with the following systems; MMIS/Medicaid Management Information Systems, HBX/Health Benefits Exchange and CARES/Client Automatic Resource Eligibility Systems. 

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.

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 employment (eligible) list for at least one year.

The examination will consist of a rating of your education, training, and experience as presented on your application and as they relate to the requirements of the position.  You may be required to complete a supplemental question.  Therefore, it is important that you provide complete and accurate information on your application.

STATE OF MARYLAND BENEFITS

 

Applications will not be accepted after the close of business on the closing date of the announcement. Resumes will NOT be accepted in lieu of completing the online or paper application. The online application process is STRONGLY preferred.  If online access is not available, you may submit a paper application, supplemental questionnaire and resume to:

Maryland Health Benefit Exchange

Attn: Shadrick Phillips, 

 Email: shadrick.phillips1@maryland.gov

 750 E. Pratt Street, 16th Floor Baltimore, MD 21202

 TTY  Users: call via Maryland Relay 1-800-735-2258

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

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