Health Management Systems, Inc. Subrogation Specialist in Albany, New York
HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.
We are seeking a talented individual for a Subrogation Case Worker I who is responsible for processing all casualty or estate functions involving several state Medicaid beneficiaries or deceased Medicaid beneficiaries. This includes intake, maintenance, claims review and selection, management, settlement and related functions to the case.
Ensure all processes meet HIPAA and Government security requirements with regards to sharing/storage/PHI (Personal Health Information).
Utilize complex analytical skills to manage subrogation cases, notate files and negotiate settlements on 700 – 1,000 cases at a time
Interact professionally, primarily using incoming and outgoing calls, with attorneys, insurance adjusters, medical providers, court staff, recipients and family members and clients
Prepare required correspondence, liens, claims and other related documents to progress the case to recovery.
Negotiate and compromise claim/lien settlement amounts per contract guidelines.
Perform basic and advanced levels of document review to identify current case status, legal research, and case management and ensure case progress through workflow
Performs other functions as assigned
Confirm documentation of eligibility for beneficiaries.
Conduct all case document review and updates as needed.
Confirm and validate third party liability and, probate and beneficiary asset research.
Process all claim/lien disputes and review claims with attorneys and other stakeholders.
Conduct outgoing periodic follow up on case status and payment.
Prioritize case events and critical case payment/recovery issues, while meeting, various internal and legal deadlines that are revenue impacting.
Compile, analyze and make conclusions about case information and status from multiple sources.
Meet department objective standards for Customer Service, settlement goals and file handling guidelines.
Meet file handling and phone call metrics related to each case.
Knowledge, Skills and Abilities:
Medicaid and/or Medicare knowledge preferred.
Ability to interact with all levels of people both internally and externally in a professional manner.
Ability to be careful and thorough about detail including with cite-checking and proofreading skills.
Ability to multi-task and prioritize effectively.
Knowledge of Microsoft Word and Excel required
Ability to work proficiently with Microsoft Office, PowerPoint, Word, and Excel required.
Basic knowledge of Microsoft Access preferred.
Ability to work independently to meet objectives.
Ability to analyze information and use logic to address work-related issues and problems.
Ability to perform well in team environment, to achieve business goals.
Ability to maintain a high level of confidentiality and ethics.
Ability to handle pressure and manage deadline oriented project demands and multiple initiatives.
Work Conditions and Physical Demands:
Primarily sedentary work in a general office environment
Ability to communicate and exchange information
Ability to comprehend and interpret documents and data
Requires occasional standing, walking, lifting, and moving objects (up to 30 lbs.)
Requires manual dexterity to use computer, telephone and peripherals
May be required to work extended hours for special business needs
May be required to travel at least 10% of time based on business needs
- The knowledge typically acquired during the course of attaining a Bachelor’s degree in a related field is required. A combination of education and experience may be used in lieu of a degree.
- Paralegal certificate or equivalent combination of education and experience in legal field desired
Minimum Related Work Experience:
2 years of relevant experience
Experience in a Legal office preferred; paralegal or legal assistant and/or experience in the insurance industry (casualty or health insurance) preferred
Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
EOE including disability/veteran
Title: Subrogation Specialist
Location: New York-Albany
Requisition ID: 1900112R
Health Management Systems, Inc.
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