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Medical Assistance Specialist 3 - Medical Claims Processor

State of Washington Dept. of Corrections – Tumwater, WA

Description


Medical Assistance Specialist 3 Medical Claims Processor
Health Service Division/HS Contracts, Claims & Benefits Unit
Headquarters
Tumwater, WA
**This posting will be used to fill multiple positions**
**To be considered for the 1st round you must have your application submitted no later than 8:00 am on June 24, 2019, to be considered for the 2nd round you must have your application submitted no later than 8:00 am July 3, 2019 all other applications will be viewed after the posting is closed.**
The Department of Corrections is seeking a highly motivated and qualified individual to take on the dynamic role of Medical Assistance Specialist 3, Medical Claims Processor for our HS Contracts, Claims, & Benefits Unit within the Health Service Division. This is a Permanent position located at Department of Corrections Headquarters in Tumwater, Washington.
Our mission at the Department of Corrections (DOC) is to improve public safety . With a vast number of innovative sustainability programs, and evidence-based practices used to reduce recidivism, Washington State is highly regarded as a strong leader in the field of Corrections. For additional information about our agency, please visit doc.wa.gov.
The Medical Assistance Specialist 3 (MA3) provides technical support for the claims section of the Statewide Health Services Contracts, Claims and Benefits Unit (HSCCBU). This position also contributes to the Department s mission by ensuring timely and accurate processing of claims for medical services provided to offenders which, helps ensure that relationships between vendors providing goods/services and the agency are in good standing. At the expert level, determines processing or denial of provider s claims submitted to DOC by deciphering and interpreting information on claims/adjustment requests submitted electronically or on paper. Adjudicates the claims or adjustments through the ProviderOne system and through standard manual paper process.
To be considered for this position, please attach the following to your online application:
  • A detailed, chronological resume, and
  • Letter of Interest that outlines how you meet the qualifications for this position
  • A minimum of three (3) professional references with your application. A professional reference is defined as an individual who has been paid to supervise your work and can attest to your work performance, technical skills, and job competencies.

Duties

Key responsibilities of this Medical Assistance Specialist 3 Medical Claims Processor include, but are not limited to:

  • Review and authorize or deny processing of claims for medical services provided to DOC offenders both on and offsite prison grounds, as well as determine if items billed were authorized by the Department, are in compliance with the Offender Health Plan (OHP) and health services policies/protocols, n, are priced according to the fee schedules in place as of the date of service, and are from a contracted provider, and were provided to an individual who is under the Departments jurisdiction utilizing the ProviderOne (P1) payment system, and various internal data systems, as well as standard manual paper claims processing
  • Understand and apply contractual payment terms to adjust and compute appropriate payment for items billed
  • Understand and apply knowledge of the OHP and health services policies and protocols regarding medical services in the processing of claims
  • Provide excellent reporting and customer service for all stakeholders
  • Be a reliable and collaborative part of the team
  • Be able to multitask, effectively manage your time and meet required deadlines
  • Other duties as assigned

Qualifications

Required:

  • One year of experience as a Medical Assistance Specialist 2 or equivalent.
  • Recent experience in medical claims processing, billing, adjusting, and/or investigation, related work in the area of health insurance; other medical premiums/claims related experience may substitute, year for year for the required experience.
  • Knowledge and understanding of various health care coding structures (CPT, HCPCS, ICD-9, ICD-10 etc.)
  • Proficiency with Microsoft Excel and Outlook
Preferred:
  • Intermediate/Advanced skills with Microsoft Excel, Access and Outlook
  • Experience adjudicating various claim types in the ProviderOne System
  • Certified Medical Coder

Supplemental Information

The mission of DOC is to improve public safety.
For additional information about the agency, please visit doc.wa.gov.
IMPORTANT NOTES:

  • Please include a minimum of three professional references with your application. A professional reference is defined as an individual who has been paid to supervise your work and can attest to your work performance, technical skills, and job competencies. If you do not have any or sufficient professional references, please include non-related professionals, such as educators or other professional associates.
  • Phone number AND email address are required for all professional references.
  • All DOC employees are fingerprinted for a criminal history background check.
  • Employees may work directly with or in close proximity to incarcerated individuals in a potentially hazardous setting. Please consider this when deciding whether to apply.
  • We are committed to maintaining a drug and alcohol free work environment, and our employees are expected to comply with all state and federal laws. A pre-employment drug test may be administered as part of the selection process, and applicants who test positive for any controlled substances, will be disqualified from consideration.
  • Oleoresin Capsicum (OC) is an aerosol pepper spray made available as a means of self-defense and/or de-escalation. Applicants with sensitivities or allergies are encouraged to ask about the level of exposure they could expect in this position.
  • Animal care projects are a common component of most Washington State prisons, including dog and cat programs. Applicants with animal sensitivities or allergies are encouraged to ask about the level of exposure they could expect in this position.
  • Tuberculosis (TB) is a priority health issue for DOC employees. The successful candidate may be required to provide valid proof of a baseline TB skin test within 60 days from the date of hire. When positive tests result, further information, testing and treatment may also be required. Employment is not contingent upon test results.
  • This position may be included in a Union Shop.

We are committed to hiring individuals who possess core diversity competencies:
  • Foster a positive attitude and openness toward the ever changing social and cultural makeup of the workplace.
  • Work effectively with men and women of different perspectives, abilities, disabilities, races, religions, ages, lifestyle preferences and social, ethnic and cultural backgrounds.
  • Respectfully acknowledge people s differences and recognize these differences as important and valuable.
  • Promote inclusiveness.
  • Be culturally sensitive and appropriate.
  • Respect and value diverse backgrounds and traditions.

DOC is an equal opportunity employer and does not discriminate on the basis of race, creed, color, national origin, sex, marital status, sexual orientation, gender identity diversity, age, honorably discharged veteran, veteran status, genetic information, or the presence of any sensory, mental or physical disability or the use of a trained guide dog or service animal by a person with a disability.
For questions about this recruitment, or to request reasonable accommodation in the application process, please email dochqhr@doc.wa.gov or call us at (360) 725-8459. For TTY service, please call the Washington Relay Service at 7-1-1 or 1-800-833-6388.

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