|Date Opened||7/12/2023 12:00:00 AM|
|Salary||$56,535 - $73,676/year *Individuals new to State Service start at the minimum|
|Job Type||Open to the Public|
|Close Date||7/20/2023 11:59:00 PM|
Are you seeking an opportunity to utilize your background in financial record keeping, auditing, accounting and or purchasing and claims processing? If so, we encourage you to apply for the Associate Claims Examiner position!
The Convalescent Unit staff work directly with nursing homes, many of which have experienced financial hardship and have a high level of turn-over within their billing departments. This unit is responsible for ensuring that the Nursing home has utilized all Medicare and/or insurance benefits that may cover room and board charges for Medicaid clients before initiating payment authorization on the ImpaCT system. This work is critical to ensuring timely payment to nursing homes once Medicaid becomes the primary payer. The Convalescent Accounting Unit also identifies and recovers Medicaid payments due to additional Medicare or insurance coverage. The Convalescent Accounting Unit responds to written and telephone inquiries pertaining to eligibility, authorization, and claims payment. Staff often attend meetings with nursing homes regarding payment or recoveries.
Comprehensive Benefit Offerings:
In your role as an Associate Claims Examiner, you will have the opportunity to:
Department Overview:The State of Connecticut, Department of Social Services (DSS) delivers and funds a wide range of programs and services as Connecticut’s multi-faceted health and human services agency. DSS services about 1 million residents of all ages in all 169 Connecticut cities and towns. We support the basic needs of children, families, older and other adults, including persons with disabilities. Services are delivered through 12 field offices, central administration, online and phone access options. Follow us on twitter @ctdss and see what we are all about!
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DEPARTMENT OF SOCIAL SERVICES AND OFFICE OF THE TREASURER: This class is accountable for performing the most complex tasks related to the examination of claims and supporting documentation for validity, legality and subsequent approval for payment.
OFFICES OF POLICY AND MANAGEMENT [INTERGOVERNMENTAL RELATIONS DIVISION] AND STATE COMPTROLLER: This class is accountable for acting as a working supervisor for Claims Examiners engaged in examining claims and supporting documentation for validity, legality and subsequent approval for payment.
DEPARTMENT OF SOCIAL SERVICES: Performs specialized duties relating to examination of claims for convalescent care benefits; ensures Medicaid is payor of last resort by reviewing client coverage for Medicare or private health insurance submitted by providers; determines correct payment authorization by applying knowledge of agency policy, state statute and federal regulations; determines proper payment authorization date by identifying third party payment amounts and coverage dates and applying these to benefit claims; reconciles suspect duplicate claims identified by payment contractor and approves correct payment and/or initiates recovery of inappropriately paid claim; analyzes Medicare reconsideration listings or reversals received from Third Party Liability unit to determine proper payment authorization or recovery; acts as liaison for assigned facility for payments processing and recovery; provides training for facility staff regarding payment authorization requirements and policies; documents overpayments through review of various records and reports and determination of correct benefit periods; initiates recovery of Medicaid benefits for claims paid prior to application of other available medical coverage; receives and responds to high volume of telephone calls and written correspondence regarding billing problems, denied claims and other issues from a variety of individuals; performs related duties as required.
OFFICES OF POLICY AND MANAGEMENT [INTERGOVERNMENTAL RELATIONS DIVISION] AND STATE COMPTROLLER: Plans unit workflow and determines priorities; schedules, assigns, oversees, and reviews work; establishes and maintains unit procedures; provides staff training and assistance; conducts or assists in conducting performance evaluations; acts as liaison with operating units, agencies and outside officials regarding unit policies and procedures; performs a full range of liability and expenditure audits of the State of Connecticut with emphasis on most complex audit requirements; coordinates and monitors work of employees performing audit of liabilities and expenditures for validity, legality and propriety; attends meetings with state agencies regarding audit items; advises and instructs state on liability and expenditure matters; prepares analytical and audit reports; provides information to Auditors of Public Accounts as necessary; trains new Claims Examiners as necessary; may make recommendations on polices or standards; may prepare reports and correspondence; performs related duties as required.
OFFICE OF THE TREASURER: Performs specialized duties related to examination of claims for purposes of returning people to work, negotiating settlements and uncovering fraud; develops or assists in development of indemnity and medical reserves as well as reserve reassessment based upon new information or a change in circumstance; develops and implements claim file action plan by interpreting medical reports and utilizing in-house and outside resources including but not limited to independent medical evaluations, surveillance, Attorney General referral and/or vocational assistance; identifies and resolves disputed issues pursuant to Connecticut General Statute Chapter 568; prepares for and attends Workers Compensation hearings as needed; performs related duties as required.
Five (5) years of experience in highly complex clerical work involving financial record keeping, auditing, accounting, purchasing or claim processing.
One (1) year of the General Experience must have included accounts payable and/or claims auditing.
Note: For state employees experience in highly complex clerical work is interpreted as experience obtained at the level of Financial Clerk
AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER
The State of Connecticut is an equal opportunity/affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.