Appeals Officer

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:

• PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans

• Medical, Dental, and Vision insurance coverage

• Automatic Short-Term and Optional Long-Term Disability Coverage

• Life and AD&D Insurance

• Flexible Spending Accounts (FSAs)

• Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)

• 11 Paid Holidays Annually and Accrued Annual and Sick Leave

• Accrued Sick Leave for State of Colorado Temporary Employees

• Flexplace and Flextime work arrangements

• 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

• Credit Union of Colorado Membership Eligibility

• Some positions may qualify for the Public Service Loan Forgiveness Program. For more

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. 

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:

• Review and analyze the record, exhibits, Initial Decision, and any exceptions or transcripts to determine the correctness of the Initial Decision.
• 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.
• Use independent legal decisions to analyze the Initial Decision in each individual case.
• Resolve all Medicaid appeals without higher level approval.

 


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

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

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 (dpa_state.personnelboard@state.co.us), 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.

How to Apply (PLEASE READ CAREFULLY)

Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.

Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.

Comparative Analysis Process

The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.

Failure to submit properly completed documents by the closing date will result in your application being rejected.

ADAAA Accommodations: The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.

The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Virginia Miller, at virginia.miller@state.co.us.

The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.

Salary : $91,272 - $146,040