The Coordination of Benefits (COB) unit is looking for an individual to join a dynamic group of professionals within the Department of Vermont Health Access. The COB Unit works with providers, beneficiaries, probate courts, attorneys, health and liability insurance companies, employers, and Medicare Parts A, B, C & D plans to ensure that Medicaid is the payer of last resort, through coordination of benefits and collections practices. States are mandated to have a system to identify medical services that are the legal obligation of third parties, such as private health or accident insurers. Third-party resources should be exhausted prior to paying claims with program funds. If a liable third-party is established after a claim is paid, reimbursement from that third party should be sought. Individuals eligible for Medicaid assign their rights to third party payments to the State Medicaid Agency
As an important member of the Casualty, Estate and Long-Term Care (LTC) Recoveries team within the COB unit, the primary responsibilities of this position include: billing and collection of funds from insurance companies and/or attorney's for services paid for by DVHA determined to be the responsibility of another party, updating the TPL system, case tracking, recoupments, and return checks. These duties will be performed using the following applications/systems: Medicaid Management Information System (MMIS), the State of Vermont's Third Party Liability system, VTrans System, ACCESS, Business Objects, and others. These duties may involve interaction with private insurers, employers, the State of Vermont's fiscal agent DXC, and other state employees via phone, letters, email, and/or faxes.
Other assigned duties may include, but are not limited to; representing the unit as a liaison and providing back-up support for various other tasks such as LTC, Estate, Trusts, and Annuity Recoveries, as well as Federal and State policy interpretation, and other projects as needed. You will work closely with the State's Fiscal Agent, DXC, to ensure information accuracy within the MMIS.
We are looking for a patient individual with an innovative mindset that has excellent professional verbal and written communication skills. This individual must possess the ability to multi-task in a fast paced environment and use multiple computer applications and systems at once. Working knowledge of Microsoft Suite, particularly Word and Excel is highly preferred as well as knowledge of health insurer claims processing. Knowledge of medical terminology is helpful but not required. This position must maintain confidentiality based on HIPAA.
All work is performed under the general direction of the Coordination of Benefits Director and/or Supervisor.
This position will move to Waterbury in early 2019.
Who May Apply
This position, DVHA Program Consultant- Limited Service (Job Requisition # 330), is open to all State employees and external applicants.
This is a limited service position which is authorized through 6/30/21. Limited service positions are budgeted each year and can be extended accordingly based on programs and funding
If you would like more information about this position, please contact Samantha Prince at firstname.lastname@example.org.
Please note that multiple positions in the same work location may be filled from this job posting.
***In accordance with Title 23, Section 102(d), an applicant must agree to be finger-printed and pass a background investigation to be eligible for this position. The background investigation may include criminal, financial and traffic records checks. Hiring managers will notify applicants who are in the final stage of the interview process of the finger-printing and background check requirement, to which an applicant must agree to be deemed eligible for this position. Applicants will have the right to withdraw their applications before finger-printing and/or a background investigation is conducted.***
Resumes will not be accepted via e-mail. You must apply online to be considered.
Technical, analytical and consulting work in the Department of Vermont Health Access (DVHA) involving the planning, development and continuing assessment (review) of one or more publicly funded health insurance programs such as Medicaid, the Vermont Health Access Plan (VHAP), VHAP Pharmacy, VScript, VScript Expanded, Healthy Vermonters, V-Pharm, and/or Vermont-RX. Duties are performed under the general direction of the Unit Director or a Unit supervisor, but involve extensive interaction with other unit directors, Agency of Human Services district directors and supervisors, assistant attorneys general, other Agency of Human Services program managers, contractors, health insurance providers, and federal officials. Supervision of office staff may occur on a regular or project basis. All employees of the Agency of Human Services perform their respective functions adhering to four key practices: customer service, holistic service, strengths-based relationships and results orientation.
Work is generally performed within the normal office setting.
Some means of private transportation must be available for field visits. Work activities during the evening or weekend may occur, and some out-of-state travel may be required. Conflicting opinions relative to the correct application of rules, regulations and policies can be anticipated.
Bachelor's degree AND one (1) year or more of experience in a healthcare or health insurance field.
High School diploma or equivalent and four (4) years or more of experience in a field related to accounting, auditing, federal grants management, business administration or public or health administration or a provision of educational support services.
Candidates must pass any level of background investigation applicable to the position. In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.
As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits that are worth about 30% of your total compensation, including:
80% State paid medical premium
Dental Plan at no cost for employees and their families
Flexible Spending healthcare and childcare reimbursement accounts
Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
Work/Life balance: 11 paid holidays each year and a generous leave plan; many jobs also allow for a flexible schedule
Low cost group life insurance
Incentive-based Wellness Program
Qualified Employer for Public Service Student Loan Forgiveness Program
Want the specifics? Explore the Benefits of State Employment on our website.
Equal Opportunity Employer
The State of Vermont is an Equal Opportunity Employer. Applications from women, individuals with disabilities, veterans, and people from diverse cultural backgrounds are encouraged.