[Hiring] Casualty Case Manager @State of Washington

Role Description

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
• 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.

This position supports the Health Care Authority’s mission by ensuring Medicaid is the payer of last resort. Responsibilities include:

• Investigating, analyzing, and preparing casualty litigation cases
• Pursuing recovery of expended state and federal Medicaid funds from liable third parties for medical claims payments related to personal injuries
• Applying tort and case law and making 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 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.

Duties

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

• 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 and 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
• 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
• 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

Benefits

• Meaningful work with friendly co-workers who care about those we serve
• A clear agency mission that drives our work and is person-centered
• A healthy work/life balance, including alternative/flexible schedules and mobile work options
• A great total compensation and benefit package
• A safe, pleasant workplace in a convenient location with restaurants and shopping nearby
• Tuition reimbursement
• Free parking