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    Appeals Administrative Specialist - Raleigh, United States - State of North Carolina

    State of North Carolina
    State of North Carolina Raleigh, United States

    3 weeks ago

    Default job background
    Description
    This position is exempt from the State Human Resources Act


    TELEWORK AVAILABILITY:

    We trust our employees to be self-motivated and successful in hybrid/remote roles; NC Department of Health and Human Services offers work from home options and variable work schedule flexibility for this position.


    Division of Health Benefits employees with an approved hybrid telework schedule are currently expected to work onsite at their assigned duty station at least 4 working days per month or more as needed for business operations.

    Telework options are subject to change at the discretion of management. More information on this arrangement may be obtained at the time of interview.

    This position's duty station is assigned to Dix Campus in Raleigh, North Carolina.

    Position Summary


    The Division of Health Benefits Legal Office supports the legal and compliance functions for Medicaid within the State of North Carolina.

    In addition, the Legal Office provides executive oversight and leadership for the Hearings and Appeals Unit.

    The Hearings and Appeals Unit provides coordination of fee-for-service appeals and grievances by beneficiaries and claimants and provide oversight and monitoring of appeals and grievances under managed care.

    The unit also manages due process compliance which includes training, tactical oversight, and stakeholder coordination. The unit coordinates with the Department of Justice (DOJ), the Attorney General's Office and other external stakeholders.

    The Appeals Administrative Specialist reports to the Associate Director (AD) of Appeals. This position provides administrative support to the AD, managers, and other staff.

    Job Specific Responsibilities


    • Provide information by request via Unit and Division main phone lines and in person interactions.
    • Schedule meetings, taking minutes and providing phone coverage to ensure timely responses to Medicaid beneficiaries (to include rotating coverage of phones in the event of staff shortages).
    • Organize and prepare for events, meetings, site visits, and audits as well as material preparation for attendees (includes presentation materials, packets, agendas, and handouts).
    • Prepare, order and distribute monthly supply orders for staff.
    • Manage mailings and mail distribution for Unit teams.
    • Review memos, letters, templates for quality and accuracy prior to public dissemination.
    • Assist with contract performance monitoring by taking meeting minutes, tracking invoices and monitoring timeliness of vendor deliverables.
    • Assist with filing and archiving documents and tracks scheduled retention of documents.
    • Prepare routine Appeals data reports related to hearings, appeals and provider reconsideration requests.
    • Perform routine monitoring of DHB Appeals Unit's website for content accuracy and functionality, and work with appropriate departments to resolve issues identified.
    • Utilize several software systems and/or databases to enter, retrieve, verify, update, research, and/or authorize actions (primarily in NC Tracks).


    To receive credit for all of your work history and credentials, you must list the information on the application form.

    Any information listed under the text resume section or on an attachment will not be considered for qualifying credit.

    Qualified applicants must document on the application that they possess all of the following:


    • Experience communicating effectively with internal and external stakeholders.
    • Demonstrated ability to present ideas clearly and effectively in written form utilizing correct grammar, organization, and structure; proven ability to adjust language or terminology to meet the needs of the audience.
    • Documented experience recording, compiling, summarizing, and performing basic analysis of narrative materials.
    • Previous experience taking minutes, transcribing, and finalizing reports.
    • Experience analyzing and interpreting policy and procedural guidelines and independently resolving problems and questions.
    • Considerable proficiency in Microsoft Office software including Excel, Outlook, PowerPoint, and Word.

    Management Preferences:

    • Previous and proven work experience at Division of Health Benefits/NC Medicaid.
    • Familiarity with relevant and current NC Medicaid operations.
    • Proven work experience in NC Tracks.
    • Previous work experience providing administrative support in local or state government office.
    • Previous work experience with E-Procurement.
    • Working knowledge of Tableau.
    • Knowledge of Medicaid and/or Medicare programs and third-party payer methods desired.
    • Familiarity with medical terminology or health insurance terminology.


    Some state job postings say you can qualify by an "equivalent combination of education and experience." If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both.

    See for details.


    High school diploma or General Educational Development (GED) diploma and two years of related administrative experience; or equivalent combination of education and experience.

    Degrees must be from appropriately accredited colleges or universities.

    The North Carolina Department of Health and Human Services is an Equal Opportunity Employer.

    Pre-employment criminal background checks are required for all positions with the Division of Health Benefits (DHB).

    About NC Medicaid (Division of Health Benefits)


    The North Carolina Department of Health and Human Services (NCDHHS) works closely with beneficiaries, health care professionals, community leaders and advocacy groups; local, state and federal entities; and other community partners vested to improve the health and safety of all North Carolinians by providing essential human services.

    NCDHHS is one of the largest, most complex agencies in the state, with about 17,000 employees.


    The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians.

    DHB manages and oversees North Carolina Medicaid, NC Medicaid Managed Care and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders.

    With a budget over $21 billion in state and federal funds per fiscal year, DHB ensures that more than 96,000 enrolled providers are reimbursed for delivering covered services to 2.9 million beneficiaries.


    Realizing the strength of DHB lies in its employees, DHB remains dedicated in its efforts to create and maintain a diverse, equitable and inclusive workplace environment.

    Application Process

    Applicants are encouraged to apply for positions of interest, regardless of their current grade level and job classification. A pay increase may or may not result. Salary decisions are based on relevant education and experience, budget, and internal equity.


    To be under consideration for this vacancy, all applicants must complete an online application using this link: If multiple applications are submitted to an individual posting, only the most recent application received prior to the posting close date will be evaluated for consideration.

    Due to the volume of applications received, we are unable to provide information regarding the status of your application. To check the status of your application, please log in to your account.

    You will either receive a call or email to schedule an interview or an email notifying you when the job has been filled.

    For technical issues with your application, please call the NeoGov Help Line at If there are any questions about this posting other than your application status, please contact us at
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