Casualty Case Manager; MAS​/AHSO

Overview

Casualty Case Manager (MAS3/AHSO)

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.

• 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 Provider One 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 programs including, but not limited to:
  Provider One, 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.

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 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; or
• Experience researching and analyzing complex rules, regulations…