Incumbents, under general direction, preside over formal quasi-judicial provider reimbursement hearings which guarantee procedural safeguards of the Administrative Procedure Act or such due process safeguards set out in State law and regulations promulgated thereunder; render proposed decisions or alternative decisions for the Director; assist in development of system and technical improvements of administrative law and procedures; and perform other related work.
Incumbents conduct formal administrative hearings and prepare proposed decisions for consideration of the Director or to be responsible for the administrative operation of the hearings of the Department. Incumbents preside over or conduct adjudicative hearings on disputed overpayments to Medi-Cal providers revealed through departmental audits or investigations; control the course of the hearing; secure its reasonable expedition and orderly conduct throughout; administer oaths; instruct participants at hearings as to their rights; question witnesses; rule on the burden and order of proof, relevancy, or admissibility of evidence as provided by law; issue subpoenas for the attendance of witnesses or the production of necessary books, papers, documents, or other evidence; receive and review evidence in written form; examine testimony taken by deposition; prepare proposed written decisions from transcripts and evidence submitted containing findings of facts and conclusions of law and recommended actions, or advise and assist the Department in formulating a decision; prepare reports to supplement findings and recommendations assuring a court reviewable record, certifies to official acts of the Department; forward necessary information to the proper parties when appeals are carried to higher authorities; confer with superior officers and officials of the Department on matters of policy, procedure, interpretation, and submit recommendations to the various officials concerned; conduct hearings on Prepaid Health Plan (PHP) emergency claims disputes with non-Medi-Cal providers, and conduct public hearings on renewal or acceptance of PHP provider contracts; and conduct hearings for other departments within the Agency pursuant to interdepartmental agreements; serve as Chief Administrator for the administrative hearing and audit appeals program; direct lower level Administrative Law Judges, Hearing Auditors, and administrative staff; and do other related work.
Active membership in The State Bar of California and admission to practice law in any state in the United States or the District of Columbia for a least five years immediately preceding application for appointment. (Applicants for the Administrative Law Judge examination with four years of qualifying experience will be admitted to the examination but must complete the required five years before becoming eligible for appointment.) and Either I One year of experience in the conduct or judicial or quasi-judicial hearings in the capacity of presiding officer.
Five years of experience in the practice of law*, which shall have included at least two years of experience in the presentation of evidence and the examination of witnesses before a trial court or quasi-judicial administrative body.
Knowledge of: Title XIX of the Social Security Act, the State Medi-Cal, and provider reimbursement principles issued thereunder; State lien law and its application to Medi-Cal funding; hearing proceedings and the provisions of the Administrative Procedure Act; rules of evidence governing such procedure and laws relating to serving notices, taking depositions, and issuing subpoenas; legal research; court decisions interpreting the powers of administrative boards and agencies; principles and theories of administrative law and the judicial review of administrative actions; principles and objectives of effective public administrative and an understanding of the uses of proper administration procedures in furthering these objectives; and legal terms and forms in common use.
Ability to: Perform research; analyze, appraise, and apply legal principles, evidentiary rules, and precedents to legal problems; make accurate summaries of evidence and prepare appropriate findings and conclusions of law and make recommendations based on such facts; conduct fair and impartial hearings in a manner that will consider all pertinent evidence and secure confidence and respect; maintain a fair and impartial attitude; communicate effectively; and establish and maintain cooperative working relations.
* Experience in the "practice of law" or "performing legal duties" is defined as only that legal experience acquired after admission to The Bar.