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

State of Oregon

  • Salem, OR
  • $5,842-8,967 per month
  • Permanent
  • Full-time
  • 10 days ago
Initial Posting Date: 08/25/2025Application Deadline: 09/04/2025Agency: Oregon Health AuthoritySalary Range: $5,842 - $8,967Position Type: EmployeePosition 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 .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 ForMinimum 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 Range $4,833 - $7,407):Four years experience doing administrative research that included compiling and evaluating facts to recommend management action or decide compliance with program guidelines and regulations. Two of the four years must be above the technical support level. (Note: some positions may require experience in a specific regulatory industry or program)
Note: college-level course work may substitute for experience on the basis of 45-quarter units per year, up to a maximum of three years .Desired Attributes: The following are skills and lived experiences that we have identified as key to success in this role at OHA. These are the attributes we are looking for in our top candidate. If you possess any of these, please let us know in your application.
  • Experience supporting the development and implementation of policies and programs at the community, state, and/or national level that advance health equity (address systemic health disparities, expand culturally responsive and inclusive services, factor in social determinants of health) and elevate the voice of community and those with lived experience.
  • Knowledge of health services delivery systems, particularly the Oregon Health Plan/ Medicaid administration in Oregon and relational landscape of key partners, providers, community-based organizations, and advocacy groups.
  • Knowledge of legislative and regulatory processes; specific knowledge of Oregon Administrative Rules, Oregon Revised Statutes, and federal and state Medicaid laws and regulations is valued.
  • Ability to research laws, case precedent and legislative intent concerning interpretation of statutes and rules, content and application of case precedent, and to formulate policy recommendations.
  • Knowledge of quality assurance and continuous process improvement procedures including experience support for compliance monitoring.
  • Experience analyzing, researching, and drafting legal documents, and presenting and articulating the value and relevance of research, evaluation data, and evidence; specific experience planning case theory, performing case presentation, or supporting administrative hearings is valued.
  • Knowledge of the International Classification of Disease Codes, and familiarity with current medical and dental terminology.
  • Strong oral and written communication skills across a variety of forums; experience communicating qualitative and quantitative information, verbal and written, that are accessible to and understood by audiences with different levels of comprehension or interest and that are culturally responsive, inclusive, and appropriate.
We are seeking someone who shares Oregon Health Authority’s mission and values. OHA values health equity, service excellence, integrity, leadership, partnership, innovation and transparency. OHA’s health equity definition is “Oregon will have established a health system that creates health equity when all people can reach their full potential and well-being and are not disadvantaged by their race, ethnicity, language, disability, age, gender, gender identity, sexual orientation, social class, intersections among these communities or identities, or other socially determined circumstances. Achieving health equity requires the ongoing collaboration of all regions and sectors of the state, including tribal governments to address: the equitable distribution or redistributing of resources and power; and recognizing, reconciling, and rectifying historical and contemporary injustices.” OHA’s 10-year goal is to eliminate health inequities. Click , to learn more about OHA’s mission, vision and core values.Application GuidanceHow to Apply: Submission Requirements - At the time of application, ensure the work history in your applicant profile is up to date and attach a current copy of your resume and cover letter.External Candidates: Visit the to submit your application. Be sure to follow all application submission requirements. * Internal Candidates: Current State of Oregon employees must apply through their
. Be sure to follow all application submission requirements.After You Apply:
  • Before the job announcement closes, log in to your Workday account to check for pending tasks under “My Applications” and complete them.
  • Remember to check your email (including your junk folder) and Workday inbox for updates on your application.
  • We value our veterans! To ensure the security of your information, kindly follow the instructions for
found here. Please do not attach your Veterans’ preference documentation in the Resume/CV field of your application.Reminders:
  • Your candidate profile and application materials are great opportunities to showcase your interest in the position and highlight your skills and experience. Submissions will be screened for consistency and communication skills, including attention to detail, spelling, and grammar. For more tips and guidance, check out
! * This announcement is for one full-time, permanent, SEIU (union) represented, Compliance Specialist 3 position based in Salem, Oregon.
  • This is a HYBRID (65% IN-OFFICE) position. Please check SECTION 4. WORKING CONDITIONS, of the position description linked above to review more details regarding the details surrounding the working conditions.
  • Please download and save a copy of this job announcement and linked position description, as it is not available after the application deadline. For questions about the announcement, or if you require an alternate format to apply, please contact the Senior Recruiter, Stephanie Mitchell at Voice: [503-979-7679] (TTY 711) or Email:
. * For Workday technical support dial 1-855-524-5627.Benefits of Joining Our TeamWe offer a workplace that balances productivity with enjoyment; promote an atmosphere of mutual respect, dedication, and enthusiasm. You will collaborate with a team of bright individuals to work with and learn from. If you're driven by the passion to do something meaningful that changes lives, the is the place for you. We also offer a competitive benefits package including:
  • Excellent
benefits package for the employee and qualified family members with a very low monthly out-of-pocket cost. * Optional life insurance, short-term disability, long-term disability, deferred compensation savings program, and flexible spending accounts for health care and childcare expenses.
include 11 paid holidays, 3 personal business days, 8 hours of monthly sick leave, and vacation accrual starting at 8 hours per month. * Possible eligibility for the
. * Membership in the
(PERS)/ (OPSRP).
that will help grow your career with the State of Oregon.Additional Details
  • The information in your application will be used to complete an Equal Pay Analysis to determine salary placement upon hire. Visit the Department of Administrative Services
for more information. * The salary listed is the non-PERS qualifying salary range. If the successful candidate is PERS qualifying, the salary range will reflect the additional 6.95%. Review the
page for more details on the classification. * Agency does not offer visa sponsorship. Within three days of hire, applicants will be required to complete I-9 documentation and confirm authorization to work in the United States. If your employment authorization and documentation is contingent on sponsorship now or in the future, you will not meet Agency employment eligibility standards.Helpful Links & Resources|The Oregon Health Authority is an affirmative action and equal opportunity employer, committed to fair employment practices and pay equity for all employees. We do not discriminate based on any protected class—including race, sex, veteran status, disability, age, color, religion, national origin, marital status, or sexual orientation—and we do not screen applicants based on current or past compensation. Salary is determined through a fair review of your education, experience, and training as it relates to the position.OHA is an anti-racist organization working to eliminate health inequities and dismantle structural barriers that impact underserved communities. Join us in advancing our Strategic Plan and building a more equitable Oregon.

State of Oregon