HEARING MANAGER/MEDICAL ASSISTANCE 21342

7/16/90 A

This is the second and managerial level class in a series for professional positions responsible for conducting administrative hearings or appeals from applicants and recipients to the Department of Medical Assistance Services (DMAS). Positions in this class manage the day-to-day administrative hearing activities related to Medicaid and state and local hospitalization appeals. The work involves supervising a staff of Hearing Officers/Medical Assistance, program support and office support positions, reviewing written decisions on complex issues involving financial and categorical eligibility for Medicaid and state and local hospitalization, ensuring that hearing functions are performed in accordance with medical assistance policies, regulations and laws, and performing administrative management functions such as responding to inquiries on appeals issues. This class is distinguished from the class, Hearing Officer/Medical Assistance, by the latter's responsibility for conducting administrative hearings. This class is distinguished from the Hearing Director/Medical Assistance by the latter's responsibility for overall management of the division's operation.

Complexity of Work: Performs work of considerable difficulty that requires overseeing the activities related to the hearing program to ensure the quality and efficiency of the work performed and consistency in the application of policies, regulations, and laws related to Medicaid and state and local hospitalization. The work typically involves reviewing all written decisions prepared by the hearing officers for consistency and compliance with applicable regulations and ensuring that appeal cases are completed in the time frame mandated by federal regulations. Serves as a liaison between hearing officers, management, and appeals officers on interpretations of Medicaid and state and local hospitalization policies and procedures. Assigns and monitors the work of clerical and program support staff and oversees activities related to the automated logging of appeals cases. Responds to inquiries from elected officials, the general public and other agencies on appeals issues. Resolves complaints concerning the appeals process. Provides data on appeals for research and for reports to agency upper management and the Department of Social Services. Prepares productivity reports for the hearing director. Conducts hearings of unusual complexity of precedence when necessary. Supervises and conducts performance evaluations and recommends hiring of subordinate staff.

Supervision Given: Provides supervision to a staff of Hearing Officers/Medical Assistance that are responsible for conducting administrative hearings on a statewide basis and a staff of program support and office support staff supporting hearing activities.

Supervision Received: General direction is received from a Hearing Director/Medical Assistance who reviews summaries of appeal decisions and identifies concerns on requirements of the Medicaid Manual, State Plan, federal regulations, and due process procedures; and reviews productivity reports and discusses with the Hearing Manager/ Medical Assistance.

Scope: Positions in this class affect the overall activities of the hearing program and staff involved with conducting first level administrative hearings related to financial and categorical eligibility for Medicaid and state and local hospitalization.

Impact of Actions: Improper oversight of the hearing program may result in financial or medical problems for recipients resulting in life threatening situations, litigation against the agency and time and money costs to correct errors. Proper oversight will maintain the integrity and credibility of the agency and public goodwill.

Personal Contacts: Frequent internal and external contact with local social services and health departments, appellants, the general public, attorneys, health care providers, other state agencies, and elected officials and their staffs to obtain and provide information on hearings.

Knowledge: Considerable knowledge of federal and state policies, procedures and regulations regarding public assistance and the processes for conducting hearings. Working knowledge of managerial principles and practices.

Skills: None identified for this class.

Abilities: Demonstrated ability to interpret and apply complex regulations, analyze data, communicate effectively orally and in writing, manage strict schedules and organize work activities, and to supervise and evaluate staff performance.

QUALIFICATIONS GUIDE*

Licenses or Certification: None.

Education or Training: Graduation from an accredited college or university with course work in social work, public administration, or a related social service field.

Level and Type of Experience: Considerable experience in conducting hearings; or some managerial or supervisory experience which included interpretation of public assistance programs, analytical writing, policy interpretation, or related activities.

An equivalent combination of training and experience indicating possession of the preceding knowledges and abilities may substitute for this education and experience.

This class was established as a result of a classification study by the Department of Medical Assistance Services and was edited and validated as part of the Classification Review/Specification Update Program, effective July 1990.