Compliance Agent I – Medical Collections Team

State of Utah

Full Job Description
Job Description


The Office of Recovery Services in Salt Lake City is looking for a dedicated person to work as a Compliance Agent.

Principle Duties
We are looking for a Compliance Agent to perform a full range of professional research and/or collection tasks; using automated computer systems and associated business practice, research to identify and verify potentially liable third parties and ensure that the Utah State Medicaid program is the payer of last resort. They also perform the following tasks:

ensuring the accuracy of insurance coverage of Medicaid recipients by utilizing online verification sources and/or in person insurance company contacts and adds or updates verified insurance information to computer systems;
pursuing the collection of obligations, over payments and other debts owed to the state in regards to Medicaid reimbursement;
reviewing Medicaid paid claims information maintained in state computer systems and using knowledge of state and federal statute, insurance coverage and practice, filing appropriate claims to reimburse the Medicaid program;
contacting insurance companies to determine the status of filed claims by utilizing online resources and/or personal contact;
maintaining accurate computer system accounting records for medical debts to ensure that receipts are posted in accordance with established state business practice;
reviewing insurance company explanations of benefits to determine if payments and/or non payments for reimbursement were made in accordance with insurance company practice and state and federal statute;
negotiating settlement of claims using persuasive skills and legal authority;
providing customer service for clients/customers in various state agencies and private companies;
maintaining proficient computer skills in various state systems and online resources;
applying knowledge of agency rules, regulations and policies.

Ideal Candidate
The model candidate for this position is someone who is able to successfully:
communicate with insurance company and pharmacy billing
review, process, and verify accounts and account balances
perform research
negotiate settlement of claims
clearly explain laws, policy and procedures, etc. to others
utilize technologies used in an office setting proficiently
deal with people in a manner which shows sensitivity, tact, and professionalism

Why You Should Join Our Team
You will not only work with a great team, but you will also receive great benefits. Click hereto see the variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program the State of Utah offers.
The Agency
The Office of Recovery Services is part of the Department of Human Services. For more information on the Office of Recovery Services, please click here.

Supplemental Information

Risks found in the typical office setting, which is adequately lighted, heated and ventilated, e.g., safe use of office equipment, avoiding trips and falls, observing fire regulations, etc.
Typically, the employee may sit comfortably to perform the work; however, there may be some walking; standing; bending; carrying light items; driving an automobile, etc. Special physical demands are not required to perform the work.

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