Appeals Office Assistant

Appeals Program Assistant

We are looking for an Appeals Program Assistant to join our Legal Division Division of the Policy, Communications and Administration Office (PCA)!

The Office of Appeals issues Final Agency Decisions for Medicaid recipient appeals (known as the State Fair Hearing process) after hearing and an Initial Decision is issued by the Office of Administrative Courts. 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.

Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.

Description of Job

Position Summary

The Appeals Program Specialist provides comprehensive administrative and case management support for the Office of Appeals. This position serves as the primary point of coordination between the Office of Appeals, the Office of Administrative Courts (OAC), the Colorado Attorney General's Office, Department staff, county agencies, community partners, members (appellants), and their authorized representatives.

The incumbent ensures appeals are processed accurately, timely, and in compliance with applicable state and federal laws, regulations, policies, and legal procedures. This position manages appeal case records throughout the administrative and judicial review process, prepares official correspondence and legal documents, maintains case management systems, coordinates records for court proceedings, assists with ADA accommodations and HIPAA compliance, and provides technical guidance regarding appeals processes. The position requires strong organizational skills, sound judgment, attention to detail, and the ability to interpret and apply complex legal and program requirements while providing excellent customer service.

• Receive, review, research, assign, and process new appeal filings received from the Office of Administrative Courts.
• Enter and maintain appeals information within the case management system, ensuring records remain accurate and current throughout the life of each case.
• Monitor appeal case status, deadlines, and notifications to ensure compliance with statutory and regulatory timelines.
• Review incoming correspondence, identify improperly filed appeals, and reroute cases to the appropriate office or program.
• Prepare and distribute notices, correspondence, and mailings to appellants, representatives, attorneys, county departments, and other parties.
• Maintain complete and accurate case records throughout the administrative appeal and judicial review process.
• Apply knowledge of state regulations, department policies, administrative hearing procedures, and legal principles when responding to inquiries.
• Interpret appeals procedures and provide technical guidance to members, representatives, Department staff, attorneys, and Office of Administrative Courts personnel.
• Research Medicaid program policies, regulations, and legal authorities to support case processing and issue resolution.
• Assist management and staff by resolving technical case management issues and providing procedural guidance.
• Serve as the primary liaison between the Office of Appeals and the Office of Administrative Courts regarding case processing, scheduling, electronic records, transcripts, and case status.
• Coordinate with the Colorado Attorney General's Office regarding judicial review requests, certification of administrative records, and District Court filings.
• Review Initial Decisions received from Administrative Law Judges and coordinate all post-decision processing activities.
• Prepare case materials and records for Appeals Officers in accordance with statutory and agency requirements.
• Respond to inquiries regarding appeal status, hearing processes, deadlines, and procedural requirements.
• Contact members requesting expedited hearings to communicate case status and next steps.
• Assist clients requesting ADA accommodations by coordinating appropriate services.
• Work with members and authorized representatives to obtain required documentation and ensure HIPAA compliance.
• Build effective working relationships with internal staff, county partners, legal representatives, and external stakeholders.
• Maintain the integrity, organization, retention, scanning, storage, and disposition of paper and electronic appeal files.
• Process incoming and outgoing physical mail, including printing, scanning, copying, and mailing official correspondence.
• Publish and distribute statistical and operational reports as requested.
• Monitor case reports to identify processing delays and coordinate follow-up with the Office of Administrative Courts.
• Assist with Colorado Open Records Act (CORA) requests by identifying, reviewing, and producing responsive records.
• Maintain accurate documentation supporting agency reporting and record retention requirements.

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

RESIDENCY REQUIREMENT:

This posting is only open to residents of the State of Colorado at the time of submitting your application.

Class Code & Classification Description:

H4R1XX - Program Assistant I

MINIMUM QUALIFICATIONS:

There are two ways to qualify for this position:

Option 1:

Experience Only:

Four (4) years of professional experience in administrative and operational support, or an occupational field related to the work assigned to the position.

Option 2:

Education and Experience:

A combination of related education in public health, social sciences, or a field of study related to the work assignment and/or relevant experience in administrative and operational support, or an occupation related to the work assigned equal to four (4) years.

Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:

• An associate will count as two years of experience
• A bachelors will count as four years of experience
• A masters degree will count for six years of experience
• A doctorate or juris doctorate degree will count for seven years of experience

Note: Per the Job Application Fairness Act, you may redact information that identifies your age, date of birth, or dates of attendance at or graduation from an educational institution on your transcripts.

PREFERRED QUALIFICATIONS

• Previous relevant professional state experience.
• Professional experience with:
• • Prior Medicaid experience
  • Prior Administrative Law Experience
  • Prior Legal Experience
  • Experience with Salesforce

Skills to Support Success

• Excellent customer service.
• Problem solving.
• Ability to be self-motivated and self-directed, while possessing the ability to work in a team environment.
• Ability to manage competing priorities and multiple tasks.

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.color