Medical Hearings Representative Job Opening

Attention current State of Oregon employees : To apply for posted positions, please close this window and log into your Workday account and apply through the career worklet.

Do you have experience reviewing compliance, conducting investigations and writing reports? Is your background in case hearing? Have you worked in a medical/clinical environment?

The Oregon Health Authority – Health Systems Division is currently seeking a Medical Hearings Representative (Compliance Specialist 3) to join their team in Salem, Oregon. This position represents the unit in contested case hearings regarding the denial of medical services by preparing, coordinating and presenting. Additionally, it is responsible for ensuring compliance by the managed care plans with applicable federal and state rules and regulations.

What you will do!
You will review, research, and analyze complex medical data and decision notices to ensure Oregon Health Plan medical service denials are appropriate and in compliance with federal laws, state rules, regulations, contracts and agency policies. You are responsible for explaining to each claimant in understandable language the technical and legal material and ensure they understand the action subject to the hearing request.

You will write summaries to explain the facts and policy issues for contested cases. You will present arguments in hearings regarding facts and application of facts to the rules, policies and laws.

What's in it for you!
You will work with people passionate about what they do while providing needed services to Oregonians. You will be eligible for full medical, vision and dental benefits with paid sick leave, vacation, personal leave and ten paid holidays per year. Apply today!

This is a full time permanent, classified position and is represented by a union.

The Oregon Health Authority is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, age, protected veteran or disabled status, genetic information or any other protected class under state or federal law. Click here , to learn more about OHA’s mission, vision and core values.

What we are looking for!

• Five years of experience doing administrative research that included compiling and evaluating facts to recommend management action or decide compliance with program guidelines and regulations. Three of the five years must be above the technical support level ;
• Experience related to a health plan’s grievance, appeal or hearing process;
• Experience reviewing, researching and analyzing complex clinical information;

• Experience understanding and interpreting federal and state rules and regulations;
• Experience in advancing health equity, addressing systemic health disparities and collaborating with diverse, vulnerable and underrepresented populations.

How to apply:

• Complete the application

• Complete questionnaire

• Upload resume

• Upload cover Letter - no longer than 2 pages in length. Describe your experience reviewing, researching and analyzing complex clinical information and interpreting federal and state rules and regulations. Briefly explain how your [above] experience qualifies you for this position.

Need Help?

If you need assistance to participate in the application process, you are encouraged to call Janice Wallace at 503-945-5743 (voice) 8:00 am to 4:00 pm (Pacific Time) Monday through Friday. TTY users please use the Oregon Telecommunications Relay Service: 1-800-735-2900. An accommodation request related to a disability should be made as soon as possible.

Additional Information

• Please monitor your Workday account, as all communication will be sent to your Workday account. You must have a valid e-mail address to apply.
• If you are a veteran, you may receive preference. Click here for more information about veterans’ preference. If you checked that you are a veteran, we will ask you for your documents later in the process.
• We do not offer VISA sponsorships or transfers at this time – unless specifically noted. Within three days of hire, you will be required to complete the US Department of Homeland Security's I-9 form confirming authorization to work in the United States.
• If you are offered employment, the offer will be contingent upon the outcome of an abuse check, criminal records check and driving records check, and the information shall be shared with the Oregon Health Authority (OHA), Office of Human Resources (OHR). Any criminal or founded abuse history will be reviewed and could result in the withdrawal of the offer or termination of employment.
• Please only attach documents that are related to the position. Additional documents that are attached will not be reviewed.
• Applicant Help and Support webpage

The Oregon Health Authority is committed to fair employment practices and non-discrimination, including pay equity for all employees. We do not discriminate on the basis of protected class (race, sex, veteran status, disability, age, color, religion, national origin, marital status, sexual orientation) in the payment of wages or screen applicants on the basis of their current or past compensation. We determine salary by completing a review of your application materials to evaluate your related education, experience, and training for this position.

The Oregon Health Authority is an equal opportunity, affirmative action employer committed to workforce diversity.