Title: Appeals Specialist
State Role Title: Gen Admin Supv I/Coord I
Hiring Range: $20.00 - $28.00
Pay Band: UG
Agency: Dept of Med Assistance Svcs
Location: Dept of Medical Asst Services
Agency Website: www.dmas.virginia.gov
Recruitment Type: General Public - G
Job Duties
The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as an Appeals Assistant in the Appeals Division.
Job responsibilities will include, but are not limited to:
Monitor and work the Appeal Review Task Queue and Provider Appeal Review Queue in the Appeals Information Management System (AIMS) including: verifying whether the correspondence is for a client or provider appeal; verifying that new appeals were entered accurately; identifying duplicate appeals; verifying that correspondence was attached to the appropriate appeal; researching, reviewing and analyzing statutes, regulations, or Medicaid policy to determine if additional documentation or information is needed to process an appeal; and obtaining missing information necessary to process an appeal.
Provide administrative support for formal provider appeals including formal appeal scheduling, preparation of documentary evidence, submission of briefs, submission of exceptions, and other tasks related to the formal provider appeal process.
Provide administrative support for cases filed with the Circuit Court.
Utilize systems and databases including: the Appeals Information Management System (AIMS); Virginia Case Management System (VaCMS); and the Medicaid Management Information System (MMIS).
Provide excellent customer service, treating everyone who interacts with the Division with respect and dignity; ensure every appellant receives full due process; support a collaborative and positive work environment; and produce a quality work product.
The position you are applying for is an Hourly/Wage position. Hourly (wage) employees may not work more than an average of 29 hours a week and cannot exceed 1500 hours during their employment year. This position does not include health insurance, retirement or leave.
Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org/
The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage.
DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability.
At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.
Minimum Qualifications
Competitive candidates will meet these Minimum Qualifications:
Experience applying knowledge of programs, operations, and administrative policies and procedures in a setting such as a law office, court system, or government agency.
Experience gathering facts, analyzing findings, reaching logical conclusions, and recommending solutions.
Experience planning and coordinating administrative and support services.
Experience utilizing case management systems.
Considerable experience with technology, including MS Office.
Experience interpreting federal and state laws and regulations.
Experience in managing competing priorities and meeting deadlines.
Experience with internal and external stakeholders.
Experience in a fast-paced, deadline-driven environment.
Additional Considerations
There are no Additional Considerations for this position.
Special Instructions
You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.
The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the E‐Verify Program.
The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth’s Department of Human Resource Management Policy 1.61 Teleworking.
This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references.
If you wish to apply for a job with the Department of Medical Assistance Services, an application and/or resume for employment must be submitted electronically through this website. Mailed, faxed, emailed, or hand-delivered applications/resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and/or resume submitted before the closing date.
Applications and/or resumes should include relevant work history which indicates your qualifications for this position.
The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce.
In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155
The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.
Contact Information
Name: DMAS Talent Acquisition
Phone: 804-225-4407
Email: askhcdtalentacq@dmas.virginia.gov
In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.
Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.