State of Utah
Full Job Description
Principle DutiesWe are looking for an Estate Recovery Agent who, by using automated computer systems and associated business practices: performs research to identify and verify potentially liable third parties and ensure that the Utah State Medicaid program is the payer of last resort; ensures 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; pursues the collection of obligations, overpayments and other debts owed to the state in regards to Medicaid reimbursement; reviews Medicaid paid claims information maintained in state computer systems and using knowledge of state and federal statute, insurance coverage and practices, files appropriate claims to reimburse the Medicaid program; contacts insurance companies to determine the status of filed claims by utilizing online resources and/or personal contact; maintains accurate computer system accounting records for medical debts to ensure that receipts are posted in accordance with established state business practices; reviews insurance company explanations of benefits to determine if payments and/or non payments for reimbursement were made in accordance with insurance company practices and state and federal statute; negotiates settlement of claims using persuasive skills and legal authority; provides customer service for clients/customers in various state agencies and private companies; maintains proficient computer skills in various state systems and online resources; applies knowledge of agency rules, regulations and policies. The Ideal CandidateThe model candidate for this position is someone who: has a background in researchenjoys problem solvinghas good attention to detailworks with people in a manner which shows sensitivity, tact, and professionalismWhy You Should Join Our TeamYou will not only work with a great team, but you will also receive great benefits. Click here to 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 AgencyThe Office of Recovery Services is part of the Department of Human Services. For more information on the Office of Recovery Services, please click here.
EXAMPLE OF DUTIES
The Estate Recovery Agent also performs the following tasks: Locates assets, income, property ownership, and/or employment by searching public and private records.Determines debt and establishes orders on obligations.Contacts individuals or organizations to secure delinquent payments, and/or makes payment arrangements for money due.Ensures compliance with applicable federal and/or state laws, regulations, and/or agency rules, standards and guidelines, etc.Receives, researches and responds to incoming questions or complaints; provides information, explains policy and procedures, and/or facilitates a resolution.Gathers documentation to support negotiated resolution of non-compliance issues.Writes or drafts correspondence, reports, documents and/or other written materials.Enters data into a computer system and retrieves, corrects, or deletes previously entered data.Conducts interviews to gather or clarify information.Reviews, processes, and verifies accounts and account balances.Reviews documents and reconciles discrepancies; makes needed adjustments.Researches and reviews financial records, schedules, reports, and/or problem areas.Interprets, clarifies, explains and applies agency policy and procedures, business practices, federal or state laws and regulations, etc.Conducts investigations into allegations of a variety of inappropriate activities, rules infractions or illegal actions.
This position is located in the Bureau of Medical Collections in ORS.Preference may be given to applicants with experience working third party liability referrals.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.