Appeals Officer (Term Limited).

Department Information

State Of Colorado Residency Required At Time Of Application

NOTE: This announcement may be used to fill multiple openings.

The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.

We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.

As part of the State of Colorado, HCPF offers a competitive benefits package:

• Some positions may qualify for the Public Service Loan Forgiveness Program. For more
• Medical, Dental, and Vision insurance coverage
• Life and AD&D Insurance
• Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program
• Free RTD EcoPass to all eligible State Employees
• Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)
• Automatic Short-Term and Optional Long-Term Disability Coverage
• PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans
• Flexplace and Flextime work arrangements
• Accrued Sick Leave for State of Colorado Temporary Employees
• 11 Paid Holidays Annually and Accrued Annual and Sick Leave
• Flexible Spending Accounts (FSAs)
• Credit Union of Colorado Membership Eligibility

information, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs. https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs

The Office of Appeals issues Final Agency Decisions for Medicaid recipient appeals (known as the State Fair Hearing process). The State Fair Hearing process is an interagency process where the member’s appeal is initiated at the Office of Administrative Courts and an Administrative Law Judge issues an Initial Decision. Once the Initial Decision is written, the case is transferred to the Office of Appeals for conclusion of the State Fair Hearing process. Overall, the work unit coordinates transfer of cases from the Office of Administrative Courts, recordkeeping, docketing of Initial Decisions and mailing, handling post hearing filings and answering phone calls and emails from parties concerning the department’s appeal process (providing information to parties regarding the final stage of the department’s appeal process in compliance with state and federal law). The end work product is issuance of a Final Agency Decision and preserving cases for judicial review by the District Court.Due to the legal nature of the recipient appeals process (both substantively and procedurally), the Appeals Office is housed in the legal division.

We are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from fully remote, hybrid, to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage.

Description of Job

The Policy, Communications and Administration (PCA) Office welcomes your interest in the Appeals Officer position. The Appeals Officer is responsible for issuing all written Final Agency Decisions in Medicaid recipient/applicant appeals on behalf of the State Department as part of the federally mandated State Fair Hearing process. This position is responsible for communicating with other legal representatives, the Office of Administrative Courts, the Attorney General’s Office, and State Department personnel. Because of the judicial role, the Appeals Officer must remain independent from the Department and may not directly communicate with employees concerning pending appeal matters.

Responsibilities Include

• Use independent legal decision to analyze the Initial Decision in each individual case.
• If the Appeals Officer finds that there was an error in a finding of fact or conclusion of law, the Appeals Officer has the authority to overturn or modify the Initial Decision or remand the matter back to the Office of Administrative Courts for further proceedings.
• Review and analyze the record, exhibits, Initial Decision, and any exceptions or transcripts to determine the correctness of the Initial Decision.
• Resolve all Medicaid appeals without higher level approval.

This is a term-limited position with funding through July 31, 2024 Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

Minimum Qualifications

Education and Experience:

Graduation from an accredited law school.

AND

Five years of experience practicing law (legal experience acquired after admission to the bar), two of which must have included experience appropriate to the work assignment,

and qualified candidates shall have been licensed to practice law in the State of Colorado for five years.

Substitutions

None

Preferred Qualifications

• Excellent verbal and written communication skills.
• Public Health experience, including Medicaid.
• Experience working with legal processes and procedures and/or the Office of Administrative Courts.
• Related State of Colorado experience.

DEFINITION OF PROFESSIONAL EXPERIENCE: Work that involves exercising discretion, analytical skill, judgment, personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.

CONDITIONS OF EMPLOYMENT

• All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.
• Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.
• This is a term-limited position with funding through July 31, 2024. Successful candidates will sign a Waiver of Retention Rights and normal personnel rules regarding retention will not apply.

Appeal Rights

If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.

An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email ([email protected]), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the department’s action.

For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov; contact the State Personnel Board for assistance at (303) 866-3300; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.