The incumbent in this position is responsible for recovering funds paid by the state for Medicaid Estate Recovery and Accident/Injury Subrogation cases. Duties include: working with attorneys and client representatives to recover funds paid by the state for Medicaid expenses and, maintaining a caseload and updating the system and additional documentation with recoveries received. Medicaid is mandated by the federal government to pursue cost avoidance and pay and chase third party carriers through this process
Essential 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.
- Reviews claims of Medicaid recipients to establish and collect Third Party Liability reimbursement.
- Implements established procedures to recover program funds where Third Party Liability sources have been determined.
- Investigates and monitors processing system of recovery in compliance with Medicaid Third Party Liability policy, assignment and subrogation laws, statutes of limitations and various claims processing systems.
- Conducts post-payment reviews of paid claims through interpretation of histories and accomplishes recoveries of major medical expenditures.
- Establishes measures to identify and verify third party resources to support cost-avoidance, recovery of funds and implementation into the DHSS DCIS/Pact institutional billing system.
- Maintains accurate up-to-date third party liability files and data on eligible medicaid recipients for entry into computerized system.
JOB REQUIREMENTS for Medicaid Third Party Liability Analyst
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:
- Six months experience in benefits claims processing such as health, dental, or life.
- Six months experience in interpreting laws, rules, regulations, standards, policies, and procedures.
- Six months experience in using an automated information system to enter, update, modify, delete, retrieve/inquire and report on data.
- Six months experience in narrative report writing.
- Knowledge of health care reimbursement which includes reviewing and categorizing claims for proper billing, analyzing cost reports, examining cost containment, and interpreting and analyzing laws, rules, regulations, policies, procedures and standards affecting reimbursement and recovery.
Conditions of Hire
This position is a classification organized under an exclusive bargaining representative (labor organization). The candidate selected for this position shall be asked to join and pay dues to the labor organization or may, decline joining the labor organization and not pay dues or a fee. The labor organization has been elected by employees as their representative for collective bargaining and other work related purposes.
The application and supplemental questionnaire are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position. It is essential that you provide complete and accurate information on your application and the supplemental questionnaire to include dates of employment, job title and job duties. For education and training, list name of educational provider, training course titles and summary of course content. Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment, education and training history as it relates to the job requirements.
Once you have submitted your application on-line, all future correspondence related to your application will be sent via email. Please keep your contact information current. You may also view all correspondence sent to you by the State of Delaware in the “My Applications” tab at www.delawarestatejobs.com.
Accommodations are available for applicants with disabilities in all phases of the application and employment process. To request an auxiliary aid or service please call (302) 739-5458. TDD users should call the Delaware Relay Service Number 1-800-232-5460 for assistance. The State of Delaware – An Equal Opportunity and Affirmative Action Employer.