Medicaid Appeals & Disability Representative

Essential Functions

• Requests medical records for review. Analyze the medical condition of the patient to determine if they meet a disability listing.
• Analyzes and make decisions regarding performing appeal or accepting denial. Provides Financial Counselors with input on cases requiring further medical review.
• Prepares written arguments to present to the Income Maintenance Casework, local, and state hearing officers to include preparation of witnesses for hearing.
• Analyzes legal issues applicable to the specific denial situation. Actively participates in hearing proceeding to include presentation of oral and written arguments. Reviews and responds to written summary prepared by county officers.

Physical Requirements
Works in patient's room or a fast-paced office environment with numerous interruptions. Must be able to travel to represent patient at appeals. Work closely with attorney/paralegal for guidance on difficult eligibility issues.

Education, Experience and Certifications

High School Diploma or GED required; Bachelor's Degree preferred. 5 years experience in financial counseling, DSS or Medical appeals required. Previous experience with appeals and state hearings preferred.