Medical Hearings Representative (Compliance Specialist 3) - Remote

Overview

The Medical Hearings Representative (Compliance Specialist 3) will represent the Medicaid Division in contested case hearings and resolve issues related to service denials, ensuring compliance with federal and state regulations.

In Short

• Represent Medicaid Division in hearings regarding service denials.
• Analyze complex medical records and data sources.
• Provide technical assistance and training on compliance issues.
• Research laws and case precedents for policy recommendations.
• Factor in diverse community perspectives in decision-making.
• Collaborate with various stakeholders including community organizations.
• Ensure adherence to Oregon Administrative Rules and Medicaid laws.
• Communicate effectively in both oral and written formats.
• Support the development of policies that advance health equity.
• Work in a hybrid model with 65% in-office presence.

Requirements

• Five years of administrative research experience.
• Experience in compliance with program guidelines.
• Knowledge of health services delivery systems.
• Ability to research legislative intent and case law.
• Experience drafting legal documents and case presentations.
• Strong communication skills across diverse audiences.
• Knowledge of quality assurance and improvement procedures.
• Familiarity with medical terminology and coding.
• Commitment to health equity and inclusivity.
• Ability to work collaboratively in a team environment.

Benefits

• Excellent medical, vision, and dental benefits.
• Paid holidays and personal business days.
• Training opportunities for career growth.
• Membership in the Public Employees Retirement System.
• Flexible spending accounts for healthcare and childcare.
• Possible eligibility for loan forgiveness programs.
• Supportive and inclusive workplace culture.
• Competitive salary based on experience.
• Opportunities to impact community health positively.
• Work-life balance with hybrid work model.