Compliance Agent I

State of Utah - Salt Lake County, UT3.8

We are looking for someone who, by using automated computer systems and associated business practices, perform research to identify and verify potentially liable third parties and ensure that the Utah State Medicaid program is the payer of last resort; ensure 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; pursue the collection of obligations, overpayments and other debts owed to the state in regards to Medicaid reimbursement; review 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; must maintain accurate computer system accounting records for medical debts to ensure that receipts are posted in accordance with established state business practices; review 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; negotiate settlement of claims using persuasive skills and legal authority; must provide customer service for clients/customers in various state agencies and private companies; maintain proficient computer skills in various state systems and online resources; apply knowledge of agency rules, regulations and policies.

Example of Duties:
Locates assets, income, property ownership, and/or employment by searching public and private records.
Determines debt and establishes orders on obligations.
Contact 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.

Typical Qualifications: (includes knowledge, skills, and abilities required upon entry into position and trainable after entry into position)
use logic to analyze or identify underlying principles, reasons, or facts associated with information or data to draw conclusions
find, gather and collect information or data
use automated software applications
use case management software systems
use computer spreadsheet software
maintain confidentiality
court/hearing, rules, records, procedures and protocol
enter, transcribe, record, store, or maintain information in either written or electronic form.
evaluate information against a set of standards
prepare financial reports and documentation
establish, organize and/or maintain files
agency, professional and/or industry standards and practices
applicable laws, rules, regulations and/or policies and procedures
negotiation techniques and methods
organize information in a clear and concise manner
read, interpret and apply laws, rules, regulations, policies and/or procedures
ensure compliance with contract terms, policies and procedures, etc.
compile, code, categorize, calculate, tabulate, audit, verify, or process information or data
review and/or edit documents for accuracy and completeness
reconcile financial statements
research methods, techniques, and/or sources of information
operate a computer keyboard
use computer word processing software
compose and produce reports, documents and related material
communicate information and ideas clearly, and concisely, in writing; read and understand information presented in writing
use State or agency-specific software application program(s)
grammar, spelling and punctuation
bookkeeping procedures
agency objectives, organization, structure and mission
billing codes and procedures
investigative techniques and processes

Supplemental Information:
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.