|
Commonwealth of Pennsylvania |
|
|
POSITION DESCRIPTION FOR JOB POSTING |
|
|
Position Number: 50380729 |
Description Activated On: 1/21/2026 8:38:42 AM |
Position Purpose: Describe the primary purpose of this position and how it contributes to the organization’s objectives. Example: Provides clerical and office support within the Division to ensure its operations are conducted efficiently and effectively. Responsible for the hearing and adjudication of recipient appeals, i.e., Supplemental Nutrition Assistance Program (SNAP)(formerly known as food stamps), cash assistance, medical assistance (MA) including Legacy MA and Affordable Care Act MA, Low Income Home Energy Assistance Program (LIHEAP), Program Exception and Prior Authorization appeals and non-recipient and Provider appeals, encompassing over 150 issues. These include, but are not limited to Home Care Services of the PA Department of Aging; Disability Advocacy Program appeals, Nursing Home Reimbursement appeals; Medical Assistance Provider appeals and Mental Health/Intellectual disability appeals, which are filed with the Department of Human Service's Bureau of Hearings and Appeals (BHA). Reviews recipient, provider and formal appeals for jurisdictional appropriateness, compliance with applicable rules/laws, timeliness, and other legal issues, etc. Issues Rules to Show Cause, dismissals and other legal correspondence to appellants. Makes determinations regarding appropriate handling of unperfected appeals. |
|
Description of Duties: Describe in detail the duties and responsibilities assigned to this position. Descriptions should include the major end result of the task. Example: Types correspondence, reports, and other various documents from handwritten drafts for review and signature of the supervisor. 1. Conducts quasi-judicial administrative hearings by contacting parties, explaining hearing process, ruling on pre-hearing motions, conducting pre-hearing conferences, recording hearings, administering oaths, examining witnesses, determining timeliness of appeals, clarifying issue(s), limiting testimony to relative issues involved, permitting cross-examination, ruling on motions, clarifying cited regulations, receiving exhibits, holding record open for briefs and exhibits if necessary and formally closing hearing record, thereby assuring a fair and objective hearing, maintaining an orderly hearing. Hearings may involve disputed matters on multiple issues which may involve multiple cases or groupings of cases concerning Administrative Disqualifications, discontinuances, suspensions, reductions, sanctions and related issues affecting significant groups of individuals. 2. Reviews recipient, provider and formal appeals for jurisdictional appropriateness, compliance with applicable rules/laws, timeliness, and other legal issues, etc. Issues Rules to Show Cause, dismissals and other legal correspondence to Appellants, prior to the appeal being scheduled for a hearing. Makes determinations regarding appropriate handling of unperfected appeals. Ensures that all information is complete and legally correct before forwarding the appeal to be scheduled for a hearing. 3. Completes an Adjudication and Order or Recommendation as a fact finder by objectively considering and evaluating testimony, exhibits, briefs and arguments presented at the hearing. Applies the appropriate regulation(s) accordingly. Responsible for the original jurisdiction in the conduct of administrative law fact-finding hearings and has the delegated authority of the Secretary of Human Services as per 55 Pa. Code §275.4(h)(1)(i)-(iii) to issue a binding adjudication. Work involves hearing testimony and obtaining evidence necessary to issue a sound, well-reasoned adjudication making appropriate finding of facts, researching, interpreting and applying relevant law, regulations, administrative directives and bulletins. Work involves the performance of increasingly difficult tasks with complete independence. Must comply with issuing the adjudication and order within regulatory timeframes based on state and federal laws and regulations. 4. Issues subpoenas and rules on pre-hearing motions. 5. Requires the ability to analyze testimony and evidence provided at the administrative hearing and make appropriate findings of facts. 6. Requires the necessary writing and research skills to put forth a well-written, progressively logical, legally sound, grammatically correct adjudication void of typographical errors. The adjudication and or recommendation and order must stand up to judicial review by the supervisor, regional manager, Bureau Director, the Secretary of the Department of Human Services, the Secretary of the PA Department of Aging, and Commonwealth Court. 7. Requires considerable knowledge of or the ability to acquire considerable knowledge of Department of Human Services and PA Department of Aging laws and interpretations of laws applicable to the issues being heard and adjudicated. Researches existing policies. Reads and utilizes Department handbooks and manuals, policy clarifications, bulletins and directives. 8. Requires knowledge of procedures to be followed in conducting administrative hearings. Exercises control necessary for an orderly hearing with Appellants, legal representation and Departmental representatives, affording all parties the opportunity to present testimony, cross examine witnesses and introduce evidence relevant to the issue being heard. Requires determinations on admissibility of evidence, administrations of oaths and affirmations, ruling on motions and objections and ruling on requests for reopening and rehearing appeals. 9. Requires knowledge of laws and regulations on appealable issues, timeliness and standing to determine jurisdiction of appeals brought forth. Requires ability to rule on timeliness, rule on standing and determine jurisdiction on all appeals prior to proceeding to the merits of the issue being adjudicated. 10. Requires skill in examining witnesses and/or the parties to a hearing to ascertain factual information. Requires skill in making credibility determinations with regard to testimony offered by parties. Requires knowledge of the rules of evidence in ruling on issues like hearsay evidence offered at hearings. 11. Requires skills in analyzing and appraising testimony and evidence offered to obtain a clear concept of issues involved and the weight given to testimony and evidence. Requires the ability to exercise judgment and discretion in applying and interpreting regulations, laws, precedent setting cases and policies and procedures. 12. Requires the skills to interface with Appellants, attorneys, representatives, Departmental agencies and interested parties. Parties to hearings include but are not limited to physicians, dentists, nurse practitioners, pharmacists, child and adolescent psychiatrists and psychologists, behavioral specialists, special education directors, school principals, teachers, therapeutic staff support, social workers, juvenile probation officers, nursing home administrators, court appointed guardians, claims investigative agents, child support enforcement officers, hospital administrators, and chief operating officers. When necessary, grants continuances, reschedules hearings, verifies withdrawals, and issues subpoenas. Receives and appropriately processes correspondence. 13. Provides guidance and instruction to legal assistants in responding to pre-hearing motions for continuances, subpoenas, phone calls and inquiries from all parties. 14. Maintains a system to track the status of case assignments. 15. Completes monthly reports. 16. Attends and participates in required meetings and/or training sessions as scheduled. 17. Performs other related duties and special projects as assigned. 18. Operates various office equipment in the performance of their duties which may include: videoconferencing equipment, a personal computer, recording device and/or software, telephone, FAX machine, copier, and calculator. 19. Utilizes the Enterprise Case Management system to search, manage, maintain, and process case records for assigned appeals and cases. 20. Possesses the ability to review and complete Limited English Proficiency (LEP) assessments of each case to identify if interpreter services are necessary. 21. Travels as necessary. |
Decision Making: Describe the types of decisions made by the incumbent of this position and the types of decisions referred to others. Identify the problems or issues that can be resolved at the level of this position, versus those that must be referred to the supervisor. Example: In response to a customer inquiry, this work involves researching the status of an activity and preparing a formal response for the supervisor’s signature. Independently adjudicates recipient and non-recipient cases, determines which evidence and testimony will be admitted into the hearing record and makes independent rulings on evidence, rules on the timeliness of filing, composes & completes all required documentation regarding jurisdictional matters received. Independently issues orders to Departmental agencies, Appellants and their representatives. |
||||||||||||||||||||
Requirements Profile: Identify any specific experience or requirements, such as a licensure, registration, or certification, which may be necessary to perform the functions of the position. Position-specific requirements should be consistent with a Special Requirement or other criteria identified in the classification specification covering this position. Example: Experience using Java; Professional Engineer License Experience: Licenses, registrations, or certifications: 1. N/A 2. N/A 3. N/A 4. 5. 6. |
||||||||||||||||||||
Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
|