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Job Details

Hearing Officer

Company name
N.C. Department of Health and Human Services

4 yrs required

Raleigh, NC

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Hearings Officer II

Duties : Conducts various types of hearings of adverse determinations, including but not limited to, reconsideration reviews of adverse determinations for Medicaid and Health Choice Providers by the Department of Health and Human Services, Division of Health Benefits and its vendors; appeals by residents who are being transferred or discharged from an adult care home or skilled nursing facility; appeals of Preadmission and Resident Review (PASRR) level II determinations; and second level external reviews of medical service denials or reductions for Health Choice beneficiaries. Review and process information and render accurate, impartial, and well supported decisions in accordance with Medicaid policy and State and Federal laws and regulations. Coordinate efficient scheduling of hearings with parties. Examine appeal documentation and pertinent laws and policies for each appeal case assigned. Conduct hearings in-person, telephonic, and paper appeals impartially and efficiently. Compose well-supported hearing decisions with tact and clarity using case-specific, relevant facts and the applicable rules, laws, regulation and policies. Provide overview and training of appeal process to internal and external partners. Assist in rules reviews pertaining to hearing processes and other duties as directed.

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Company Profile
The North Carolina Department of Health and Human Services (DHHS) is the agency in state government responsible for ensuring the health, safety and well being of all North Carolinians, providing human service needs for special populations including individuals who are deaf, blind, developmentally disabled and mentally ill, and helping poor North Carolinians achieve economic independence.

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