Medical Hearings Representative (Compliance Specialist 3)
State of OregonAbout the role
Initial Posting Date:
06/09/2025Application Deadline:
06/23/2025Agency:
Oregon Health AuthoritySalary Range:
$5,842 - $8,967Position Type:
EmployeePosition Title:
Medical Hearings Representative (Compliance Specialist 3)Job Description:
Opportunity Awaits, Apply Today! - Medical Hearings Representative (Compliance Specialist 3)
The primary purpose of this position is to represent Medicaid Division in contested case hearings regarding the Medicaid service denials of medical, dental, and behavioral health services; and to resolve difficult issues that could set a precedence, ultimately impacting the ability to rely on the Oregon Administrative Rules to support coverage determinations. Issues may be a result of compliance, rule application, etc.
The person in this position will review, research, and analyze complex medical records, various data sources including health studies, medical journal articles and other resources, often with conflicting information, to assure the service was denied appropriately in compliance with federal laws, state rules, regulations, contracts and agency policies. In addition, this position will research laws, case precedent and legislative intent to provide technical assistance, guidance and training to OHP members, OHA contracted plans, attorneys, DHS/OHA staff and providers concerning interpretation of statutes and rules, content and application of case precedent, and to formulate policy recommendations.
This position will factor in the perspectives of diverse populations most ha
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