Job Description:

Unwinding justification for Unwinding Capacity team: Related to the end of the Covid-19 public health emergency (PHE), the Centers for Medicaid and Medicare Services (CMS) has mandated the return to Medicaid Redeterminations, also referred to as the PHE Unwinding, which spans a 14-month period. In order for New Jersey (NJ) to comply with the CMS guidelines for Unwinding and to complete redeterminations for the largest Medicaid population ever covered by NJ, it is essential to expand our staff for the business areas impacted most by Unwinding for the period of Unwinding and any closeout requirements that may follow. This staffing position requested is a vital part of the Unwinding business needs and is critical to maintain business operations.

• Assists in researching laws, rules, and regulations necessary to fair hearings.
• Manages rapid and extensive incoming correspondence and appeal requests, per member redetermination.
• Reviews and processes fair hearing documentation for submission to the Office of Administrative Law.
• Coordinates and documents legal processes in order to facilitate the Appeals process efficiently and accurately.
• Responds to inquiries regarding program activities or requirements; refers the more complicated inquiries to senior level staff.
• Generate and issue monthly reports detailing outstanding appeal requests as well as both accepted and declined requests.
• Prepares charts, tables, and other graphic representations needed for the planning, operation, and implementation of program activities.
• Ensures compliance with federal mandates relevant to PHE Unwinding.
• Establishes processing timelines for all appeal requests in coordination with legal team.
• Utilizes various types of electronic and/or manual recording and information systems used by the agency, office or related units.

Work hours:

• 09:00 am to 05:00 pm

Job Types: Full-time, Temporary, Contract

Pay: $26.00 per hour

Expected hours: 40 per week

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Education:

• Bachelor's (Required)

Experience:

• Program Support: 1 year (Required)
• Medicaid: 1 year (Required)
• Medicare: 1 year (Preferred)

Work Location: In person