HEARING DIRECTOR/MEDICAL ASSISTANCE 21343

7/16/90 A

This class is the third and director-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 are responsible for planning and directing the administration of divisional operations for a first level Medicaid and state and local hospitalization appeals program. This class directs a staff of hearing managers, hearing officers, and clerical and administrative support personnel; develops a divisional administrative budget and strategic plan of operations; establishes divisional goals and objectives related to client relations, cases heard and compliance with existing regulations, laws and policies; supervises complex analyses of policy and legal issues related to appeals performed by the hearing managers and hearing officers; and evaluates the productivity in meeting goals. This class is distinguished from the Hearing Manager/Medical Assistance by the latter's responsibility for managing the day-to-day administrative hearing activities.

Complexity of Work: Performs work of unusual difficulty that requires the exercise of managerial and administrative abilities to plan and direct the activities of the Client Appeals Division that reviews and adjudicates Medicaid and state and local hospitalization appeals. The work typically involves budgeting for administrative operations, strategic planning, managing employee relations, analyzing fiscal impacts of proposed changes in eligibility policies affecting appeals issues, and planning and directing the work of activities of a staff of office support personnel and hearing managers who oversee activities of hearing officers and other support staff. This class reviews summaries of complex Medicaid and state and local hospitalization appeals decisions, discusses concerns related to the requirements in the Medicaid Manual, State Plan, federal regulations, and other related statutes and procedures concerning client appeals operations such as the hearing process, review of decisions for compliance with established state and federal regulations, public and agency record of policy interpretations and legal opinions from the Office of the Attorney General with hearing managers. This class also oversees the implementation of an automated appeals tracking system, researches federal and state regulations and eligibility policy for preparation of cases for litigation by the Office of the Attorney General, serves as the liaison with the Medical Assistance Appeals Panel and ensures the panel's administrative needs of case management and scheduling are met, and responds to inquiries from federal and state legislators, other states' officials, and others on appeal policies and procedures, specific Medicaid applicants' and recipients' hearing decisions, and other appeal issues.

Supervision Given: Provides supervision to support staff and a Hearing Manager/Medical Assistance responsible for first level appeals activities.

Supervision Received: Administrative direction is received from the agency director who provides necessary historical data on regulations for the logical interpretation and implementation of new legislation.

Scope: Positions in this class affect the provision of professional and administrative direction to a major agency division having first level client appeals hearing responsibility and the overall management responsibility for a staff of hearing managers, hearing officers and clerical and administrative support personnel.

Impact of Actions: Procedures and policies placed into effect by positions in this class will have a direct impact on the efficiency and effectiveness of a statewide medical assistance first level appeals program. Errors or misjudgments with regard to analyses of hearings decisions may result in payment for noncovered services, legal actions, an unfavorable public opinion of the agency, and deprivation of medical care to recipients.

Personal Contacts: Frequent internal and external contact with federal and state officials, local social services and health departments, the general public, attorneys, health care providers, other state agencies, and the Office of the Attorney General to respond to inquiries and to provide information related to appeals policies and procedures.

Knowledge: Comprehensive knowledge of the law and legal system, administrative law and appeals procedures, and of Medicaid and other medical assistance programs. Considerable knowledge of office automation, and management and budgeting principles.

Skills: None identified for this class.

Abilities: Demonstrated ability to plan, organize and manage a division composed of professional, paraprofessional and office support staff; develop and manage a budget; interpret complex regulations; and to communicate effectively orally and in writing.

QUALIFICATIONS GUIDE*

Licenses or Certification: None.

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

Level and Type of Experience: Extensive experience in administrative appeals, public benefit programs, and in supervising a professional staff that has responsibilities for public relations activities and working with elected officials.

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.