Medical Hearings Representative (Compliance Specialist 3 with CS2 underfill opportunity)

Initial Posting Date:

08/25/2025

Application Deadline:

09/04/2025

Agency:

Oregon Health Authority

Salary Range:

$5,842 - $8,967

Position Type:

Employee

Position Title:

Medical Hearings Representative (Compliance Specialist 3 with CS2 underfill opportunity)

Job Description:

Opportunity Awaits, Apply Today!  - Medical Hearings Representative (Compliance Specialist 3)

Compliance Specialist 2 (CS2) underfill opportunity available. You must be able to meet the minimum qualifications for a Compliance Specialist 3 (CS3) within 24 months of starting the position. Once you meet the minimum qualifications for a CS3 you will be reviewed for a classification change from a CS2 to a CS3.

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 harmed by social injustice and inequities including communities of color, immigrant groups, the disability and neurodivergent communities, veterans, older adults, individuals identifying as LGBTQIA+ and other communities that have been traditionally marginalized.

For a full review of the position description, please click here.

Click Here to view a Dashboard of all current recruitments for the Medicaid Division.

If this opportunity aligns with your strengths, background, and commitment to fostering inclusivity, we encourage you to apply! At the Oregon Health Authority (OHA), we value diversity and encourage applicants from all backgrounds and experiences to help us build a stronger, more equitable future for all.

What We Are Looking For

Minimum Qualifications Compliance Specialist 3 (Salary Range $5,842 - $8,967): These qualifications must be visible in your application for consideration.

Five years experience doing administrative research that included compiling and evaluating facts to recommend management action or decide compliance or eligibility with program guidelines and regulations.

Three of the five years must be above the technical support level.

College-level course work may substitute for experience on the basis of 45-quarter units per year, up to a maximum of three years.

Minimum Qualifications for Compliance Specialist 2 underfill opportunity (Salary Ra