University of Massachusetts Medical School

Specialist I, Specialty Programs

US-MA-Shrewsbury
3 weeks ago
Requisition Number
2017-29775
# of Openings
1
Shift
Day
Exempt/Non-Exempt Status
Exempt

Overview

GENERAL SUMMARY OF POSITION:

 

Under the general supervision of the Specialty Programs Unit Manager or designee, the Specialist I serves as a resource to the Center for Healthcare Financing (CHCF) staff primarily in matters concerning Casualty/Estate Recovery. This individual will ensure the integrity of collection outcomes, according to federal and state Casualty/Estate Recovery regulations and will escalate more complex cases to the appropriate staff for review.

Responsibilities

MAJOR RESPONSIBILITIES:

  • Research, maintain and understand compilation of all Federal and State statutes and regulations pertaining to Third Party and Estate Recovery to ensure Medicaid, The Department of Transitional Assistance and Health Safety Net are the payors of last resort.
  • Maintain a caseload as assigned, following established CHCF protocols and guidelines
  • Identify benefits paid by Medicaid and calculate the total value to be recovered in each case.
  • Efficiently negotiate, settle and collect all monies due within Federal and State statutes,  regulations and Medicaid documented guidelines, while adhering to all CHCF established guidelines and procedures with the approval or review of the Specialty Programs Unit Manager or designee
  • Represent the best interest of the Medicaid program consistent with the goals and objectives of CHCF
  • Request and produce claims history printouts including all service reports from Medicaid history databases for recipient payment history.
  • Investigate and document all case related matters and relevant financial and medical history in order to support a claim against the probate estate or third party settlements of a Medicaid member.
  • Maintain all case records as required for an established time period
  • Conduct legal research through the use of public databases and web based applications and prepare legal memoranda and other case related documents for referral to Medicaid EHS legal department.
  • Communicate and collaborate with probate courts, attorneys, hospitals, insurance companies and other relevant entities to insure all Medicaid related Casualty or Estate Recovery cases are referred to the unit and processed accordingly
  • Perform other job related duties as required or assigned

Qualifications

REQUIRED QUALIFICATIONS:

  • Bachelor’s Degree in Business Administration or related field, or equivalent experience
  • 2 years of related experience
  • Strong oral and written communication skills
  • Effective negation skills
  • Strong interpersonal skills
  • Familiar with insurance billing and claims inquiry
  • Ability to work on a professional level with Medicaid staff and other agencies related to third party recovery
  • Understanding of Medicaid regulations as they govern eligibility requirements
  • Proficient in Microsoft Office, web based solutions and scanning software

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