Medicaid Third Party Liability Analyst (#MDBZ11)
Summary StatementA class incumbent performs specialized social services work for the Division of Economic Services with responsibility for evaluating, adjudicating, and reviewing pending and paid medical claims for Medicaid, to determine compliance to Medical Third Party Liability program policies and third party liability resources.
Nature and ScopeAn incumbent reports to an administrative supervisor and is responsible for identifying, initiating and developing third party reimbursement cases on an individual case by case basis. Work includes evaluating and implementing established procedures to recover program funds where third party resources have been determined. An employee in this class assists in developing and implementing measures to identify and verify third party resources, recovers program funds, and processes daily pending medicaid claims for third party coverage. In addition, an incumbent works with insurance companies, recipients, fiscal agents, providers, department and division personnel and other appropriate contacts to correct billing problems, interpret policy and track and monitor parties responsible for outstanding claims and recovery. The incumbent also conducts annual post payment reviews of recipient claims histories, effects recoveries and periodic review and resolution of aged and pending cost-avoidance claims. A significant aspect of the work involves developing measures to identify and verify third party resources for cost-avoidance and recovery functions for shared use with DHSS DCIS/PACT system and maintaining up to date resource data on State and fiscal agent eligibility systems.
Essential FunctionsEssential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
Knowledge, Skills and AbilitiesThe intent of the listed knowledge, skills and abilities is to give a general indication of the core requirements for all positions in the class series; therefore, the KSA’s listed are not exhaustive or necessarily inclusive of the requirements of every position in the class.
Job Requirements JOB REQUIREMENTS for Medicaid Third Party Liability Analyst
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