CHIEF HUMAN SERVICES POLICY AND SYSTEMS SPECIALIST
Apply NowCompany: State of Rhode Island
Location: Providence, RI 02902
Description:
Salary : $79,921.00 - $90,468.00 Annually
Location : Providence, RI
Job Type: Non-Union (99)
Job Number: 2470-80701-32
Department: DEPARTMENT OF ADMINISTRATION
Division: Rhode Island Health Benefits Exchange
Opening Date: 02/21/2025
Closing Date: 3/2/2025 11:59 PM Eastern
Pay Grade: 132A
Classification: Classified
Scheduled Work Days; Hours of Work: Monday - Friday; 9:00 am to 4:30 pm
Work Week: Non-Standard
Bargaining Union: Non-Union (99)
Assignment(s)/Comments: At HealthSource RI, this role will serve as the Appeals Specialist. Please see the Supplemental-Info/Skills-Preferred section below for more specifics.
Class Definition
GENERAL STATEMENT OF DUTIES: To plan, organize and direct the analysis of human service federal regulations; to use such analysis to translate federal regulations into state human service policies, procedures and systems; and to do related work as required.
SUPERVISION RECEIVED: Works under the general direction of a superior with wide latitude for the exercise of independent judgement; work is reviewed through conferences and reports and results obtained.
SUPERVISION EXERCISED: Plans, directs, coordinates and reviews the work of a technical and clerical staff engaged in providing various human service technical analyses.
Illustrative Examples of Work Performed
To assist the supervisor in human service systems analysis in supervising the work of a staff engaged in developing systems, policies and procedures to comply with various human service federal and state regulations.
To develop human service programs intended to foster the improved delivery of services by the Department of Human Services.
To assist in the validation of computer programs used to implement human service policies.
To develop routines for use as standards for recurring manual and/or computerized operations.
To supervise the preparation of operating instructions for electronic file maintenance.
To maintain a constant awareness of federal and state legislation having an impact on poverty and human service programs and activities.
To work directly with federal agencies in the implementation of pertinent statutes.
To supervise the development and maintenance of policies and procedures maintained in electronic files.
To develop and implement written regulations which conform Department of Human Service policies to state and federal requirements.
To administer direct service programs and/or training programs.
To do related work as required.
Required Qualifications for Appointment
KNOWLEDGES, SKILLS AND CAPACITIES: A thorough knowledge of federal and state laws and regulations relating to the initiation and implementation of human service programs and systems; a thorough knowledge of state, federal, local and private resources dealing with various human service problems; a working knowledge of the principles, practices and techniques of developing informational programs and human service oriented systems; a thorough knowledge of the use of electronic file maintenance; a thorough knowledge of the principles and practices of human service systems; the ability to perform the most complex and difficult technical procedures in all systems related to the delivery of Department of Human Services; the ability to plan, direct, supervise and review the work of a technical and clerical staff engaged in providing human services and in delivering human service systems; the ability to develop systems and procedures to meet various human service needs; the ability to prepare clear and concise reports containing findings, analyses, conclusions and recommendations; the ability to establish and maintain effective working relationships with superiors, associates, and federal, state, local and private agencies and organizations; and related capacities and abilities.
EDUCATION AND EXPERIENCE:
Education: Such as may have been gained through: graduation from a college of recognized standing; and
Experience: Such as may have been gained through: employment in a highly responsible position in human service system design and policy formulation and performing complex technical, analytical, evaluative and liaison work in human services.
Or, any combination of education and experience that shall be substantially equivalent to the above education and experience.
Supplemental Information
This position is within HealthSource RI, a division of the Department of Administration. This position will serve as HSRI's Appeals Specialist. The primary function of this role is to support HSRI's General Counsel with daily operations related to the administrative appeals process. To be a successful candidate for the role, the following skills and knowledge are preferred:
Familiarity with eligibility rules under the Affordable Care Act
Familiarity with HSRI's technical systems, notices, and appeals process
Attention to detail
Analytical
Able to prioritize tasks
Excellent verbal/written communication
Key responsibilities include but are not limited to:
Track appeals from initial intake through final disposition using case management software.
Research appeal issues using the integrated eligibility system, compile evidence, and prepare proposed agency responses.
Respond to discovery requests from appellants or other parties.
Oversee appellant outreach to provide status updates or offer informal resolutions when applicable.
Represent HSRI at appeal hearings.
Manage appeals communication with other interagency and stakeholder sources.
Act as the subject matter expert for appeals and related matters.
Monitor any issues with appeals that have been identified until resolution, including eligibility pending appeal, informal resolutions, and appeal decision implementation (i.e. entering and tracking system tickets).
Identify and address appeals process breakdowns and updates.
Provide recommendations to HSRI's General Counsel on areas requiring improvement and provide data analytics to enhance the decision-making process.
Oversee distribution of feedback from hearing officers and execution of hearing decisions to ensure efficiency and prompt implementation.
Perform Tier 2 Escalation Analyst tasks as needed.
For information regarding the benefits available to State of Rhode Island employees, please visit the Office of Employee Benefits' website at
Also, be advised that a new provision in RI General Law 35-6-1 was enacted requiring direct deposit for all employees. Specific to new hires, the law requires that all employees hired after September 30, 2014 participate in direct deposit. Accordingly, any employee hired after this date will be required to participate in the direct deposit system. At the time the employee is hired, the employee shall identify a financial institution that will serve as a personal depository agency for the employee.
Location : Providence, RI
Job Type: Non-Union (99)
Job Number: 2470-80701-32
Department: DEPARTMENT OF ADMINISTRATION
Division: Rhode Island Health Benefits Exchange
Opening Date: 02/21/2025
Closing Date: 3/2/2025 11:59 PM Eastern
Pay Grade: 132A
Classification: Classified
Scheduled Work Days; Hours of Work: Monday - Friday; 9:00 am to 4:30 pm
Work Week: Non-Standard
Bargaining Union: Non-Union (99)
Assignment(s)/Comments: At HealthSource RI, this role will serve as the Appeals Specialist. Please see the Supplemental-Info/Skills-Preferred section below for more specifics.
Class Definition
GENERAL STATEMENT OF DUTIES: To plan, organize and direct the analysis of human service federal regulations; to use such analysis to translate federal regulations into state human service policies, procedures and systems; and to do related work as required.
SUPERVISION RECEIVED: Works under the general direction of a superior with wide latitude for the exercise of independent judgement; work is reviewed through conferences and reports and results obtained.
SUPERVISION EXERCISED: Plans, directs, coordinates and reviews the work of a technical and clerical staff engaged in providing various human service technical analyses.
Illustrative Examples of Work Performed
To assist the supervisor in human service systems analysis in supervising the work of a staff engaged in developing systems, policies and procedures to comply with various human service federal and state regulations.
To develop human service programs intended to foster the improved delivery of services by the Department of Human Services.
To assist in the validation of computer programs used to implement human service policies.
To develop routines for use as standards for recurring manual and/or computerized operations.
To supervise the preparation of operating instructions for electronic file maintenance.
To maintain a constant awareness of federal and state legislation having an impact on poverty and human service programs and activities.
To work directly with federal agencies in the implementation of pertinent statutes.
To supervise the development and maintenance of policies and procedures maintained in electronic files.
To develop and implement written regulations which conform Department of Human Service policies to state and federal requirements.
To administer direct service programs and/or training programs.
To do related work as required.
Required Qualifications for Appointment
KNOWLEDGES, SKILLS AND CAPACITIES: A thorough knowledge of federal and state laws and regulations relating to the initiation and implementation of human service programs and systems; a thorough knowledge of state, federal, local and private resources dealing with various human service problems; a working knowledge of the principles, practices and techniques of developing informational programs and human service oriented systems; a thorough knowledge of the use of electronic file maintenance; a thorough knowledge of the principles and practices of human service systems; the ability to perform the most complex and difficult technical procedures in all systems related to the delivery of Department of Human Services; the ability to plan, direct, supervise and review the work of a technical and clerical staff engaged in providing human services and in delivering human service systems; the ability to develop systems and procedures to meet various human service needs; the ability to prepare clear and concise reports containing findings, analyses, conclusions and recommendations; the ability to establish and maintain effective working relationships with superiors, associates, and federal, state, local and private agencies and organizations; and related capacities and abilities.
EDUCATION AND EXPERIENCE:
Education: Such as may have been gained through: graduation from a college of recognized standing; and
Experience: Such as may have been gained through: employment in a highly responsible position in human service system design and policy formulation and performing complex technical, analytical, evaluative and liaison work in human services.
Or, any combination of education and experience that shall be substantially equivalent to the above education and experience.
Supplemental Information
This position is within HealthSource RI, a division of the Department of Administration. This position will serve as HSRI's Appeals Specialist. The primary function of this role is to support HSRI's General Counsel with daily operations related to the administrative appeals process. To be a successful candidate for the role, the following skills and knowledge are preferred:
Familiarity with eligibility rules under the Affordable Care Act
Familiarity with HSRI's technical systems, notices, and appeals process
Attention to detail
Analytical
Able to prioritize tasks
Excellent verbal/written communication
Key responsibilities include but are not limited to:
Track appeals from initial intake through final disposition using case management software.
Research appeal issues using the integrated eligibility system, compile evidence, and prepare proposed agency responses.
Respond to discovery requests from appellants or other parties.
Oversee appellant outreach to provide status updates or offer informal resolutions when applicable.
Represent HSRI at appeal hearings.
Manage appeals communication with other interagency and stakeholder sources.
Act as the subject matter expert for appeals and related matters.
Monitor any issues with appeals that have been identified until resolution, including eligibility pending appeal, informal resolutions, and appeal decision implementation (i.e. entering and tracking system tickets).
Identify and address appeals process breakdowns and updates.
Provide recommendations to HSRI's General Counsel on areas requiring improvement and provide data analytics to enhance the decision-making process.
Oversee distribution of feedback from hearing officers and execution of hearing decisions to ensure efficiency and prompt implementation.
Perform Tier 2 Escalation Analyst tasks as needed.
For information regarding the benefits available to State of Rhode Island employees, please visit the Office of Employee Benefits' website at
Also, be advised that a new provision in RI General Law 35-6-1 was enacted requiring direct deposit for all employees. Specific to new hires, the law requires that all employees hired after September 30, 2014 participate in direct deposit. Accordingly, any employee hired after this date will be required to participate in the direct deposit system. At the time the employee is hired, the employee shall identify a financial institution that will serve as a personal depository agency for the employee.