Casualty Case Manager (MAS3/AHSO)

Full Job Description

Casualty Case Manager (MAS3/AHSO)

71029179

This position manages complex cases to recover funding from external entities on behalf of Medicaid clients who experience personal injury events.

This position manages a high volume of cases by investigating details, thoroughly documenting information, and communicating with the Division of Legal Services, Attorney General’s office, insurance companies, and other organizations to resolve financial outcomes.

The ideal candidate will have experience in a medical or legal setting, strong communication skills, and pay close attention to detail.

All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.

About the division:

Apple Health Services and Operations (AHSO) provides high-quality customer service to support clients' access to obtain health care, while also supporting the efficient utilization of Medicaid funding to provide care appropriately and efficiently.

About the position:

This position supports the Health Care Authority’s mission by ensuring Medicaid is the payer of last resort. This role investigates, analyzes, and prepares casualty litigation cases.

Pursues recovery of expended state and federal Medicaid funds from liable third parties for medical claims payments related to personal injuries.

Apply tort and case law and make decisions representing the department’s interest.

This position is eligible to telework and is typically not required to report on-site. The default assigned work location of all Health Care Authority (HCA) positions – both on-site and telework eligible positions – is within the State of Washington. This position reports to Olympia, WA. Frequency of onsite work will vary based on business and operational needs. HCA has currently suspended the ability to support out-of-state telework.

Requirements

Some of what you will do:

• Manage assigned casualty case files and shepherd them through the recovery process from initiation through satisfaction of final lien amount and/or case resolution.
• Investigate leads and perform a technical review of recovery resources; claims adjudication, case discovery, and collection of all related medical documentation to compile a legal case file. Carefully document case details using ProviderOne and other programs.
• Determine third party financial responsibility and make decisions representing the department’s interest.
• Evaluate, prioritize, and determine collectability of tort claims.
  • Verify client and defendant casualty insurance coverage and claim status.
  • Review claims ledger to correlate diagnostic coding, procedural coding, and services performed by qualified healthcare providers with the injuries sustained.
  • Extract pertinent information from medical records and claims to ensure case integrity and optimal reimbursement.
  • Access a variety of additional programs including, but not limited to: ProviderOne, Application Xtender/Document Manager, ACES, Excel, Word, SSPS, TPX/LINIIS, and Barcode.
• Receive notice from attorneys, investigate and examine accident information, identify and pursue third party sources of recovery. Order and utilize collision reports from Washington State Patrol (WSP) to abstract information that supports the case and seek other unreported injured clients.
• File statutory liens with counties to enforce the agency’s subrogated interest in tort settlement funds and files release of lien upon resolution.
• Monitor, track, and complete detailed documentation for all file types in Casualty Files; a web service database, to prepare litigation cases for Tort Recovery Advisor (TRA) and/or Assistant Attorney General for future possible court action.
• Serve as the agency point of contact for all personal injury cases and provide information and strategies that defend the department’s position in third party cases.
• Review and maintain Special Needs Trust cases, compile data from multiple sources and summarize calculations to update claims payment ledger, and maintain annual contact with Trustees.
• If licensed as a Notary Public in Washington State, notarize liens and releases for Casualty Unit.

Qualifications

Required qualifications:

Qualified candidates will satisfy one of the following options:

Option 1:

• Bachelor’s degree and
• One year of experience as defined below.

Option 2:

• Associate degree and
• Three years of experience as defined below.

Option 3:

• Certificate of Medical Billing and Coding or closely related certificate program
• Three years of experience as defined below.

Option 4:

• Five years of experience as defined below.

Option 5:

• One year as a Medical Assistance Specialist 2.

Qualifying experience is one or a combination of the following:

• providing direct client services or counseling of customers in the areas of health insurance, disability, or other related health benefits;
• public assistance eligibility determination;
• health insurance premiums/claims processing, adjusting, and investigation;
• other medical premiums/claims/eligibility related experience; or
• experience researching and analyzing complex rules, regulations and policies to make determinations and resolve problems while providing direct customer service.

Required competencies:

• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.

Preferred qualifications:

Knowledge of:

• Medical terminology, anatomy, procedure and diagnosis codes, and pharmaceutical usage
• Medical billing and insurance claim processes
• Tort law and legal terminology

Demonstrated experience with:

• Researching and investigating complex issues to come to a resolution
• Working independently in a role that involves critical thinking, a wide range of technical duties, and independent decision making
• Writing in a role that requires accurately documenting information to be used by teammates or other parties, e.g. case files, client information, numerical data, and/or something similar
• Communication over the phone with professionals such as attorneys, insurance companies, medical professionals, or similar
• Microsoft Office products, or similar software, including Excel and Outlook
• Strong oral and written communication skills while providing excellent customer service

Demonstrated ability to:

• Analyze medical and accident information and make appropriate determinations
• Understand and apply procedures, policies, and guidelines
• Learn new and/or increasingly complex duties

How to apply:

Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification.

To apply for this position, you will need to complete your profile which includes three professional references and attach:

• A cover letter that specifically addresses how you meet the qualifications for this position
• Current resume

To take advantage of veteran preference, please do the following:

• Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter.
• Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov.

Additional Information

About the HCA:

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and the School Employees Benefits Board (SEBB) Program.

As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.What we have to offer:

• Meaningful work with friendly co-workers who care about those we serve Voices of HCA
• A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values
• A healthy work/life balance, including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit package WA State Government Benefits
• A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.
• Tuition reimbursement
• And free parking!

Notes:

This position is covered by the Washington Federation of State Employees (WFSE). Once the listed position(s) is (are) filled, this recruitment announcement may also be used to fill additional position(s) for up to sixty (60) days.

Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.

HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency.

HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA’s mission.

Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace.

Studies have shown women, racial and ethnic minorities, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description.

Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply.

If you have any questions about the required qualifications or how your experience relates to them, please contact us at HCAjobs@hca.wa.gov.

Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Jake Nelko at jake.nelko@hca.wa.gov or 360.725.0945.

The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.

E-Verify® is a registered trademark of the U.S. Department of Homeland Security.

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