HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcarenow 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 II 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.
Effectively work, maintain and manage a variety of cases with current and accurate notes from creation to recovery
Maintain a daily system of providing timely and accurate information required to move cases through the case management workflow.
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.
Interact professionally (i.e. on incoming and outgoing calls and correspondence) with attorneys, insurance adjusters, medical providers, court staff, recipients and family members and client.
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.
Process all claim/lien disputes and review claims with attorneys and other stakeholders.
Conduct outgoing periodic follow up on case status and payment.
Perform basic and advanced levels of document review to identify current
case status, legal research, and case management and ensure case progress through workflow
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.
Complete periodic reports for management when necessary.
Ensure all processes meet HIPAA and Government security requirements with regards to sharing/storage/PHI (Personal Health Information).
May serve as an escalation point for project team
May have some training responsibilities limited to projects and specific tasks
Knowledge, Skills and Abilities:
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 proof-reading skills.
Ability to multi-task and prioritize effectively.
Ability to work proficiently with Microsoft Office, PowerPoint, Word, and Excel required
Ability to work independently to meet objectives.
Ability to analyze information and use logic to address work-related issues and problems.
Ability to perform presentations with good quality.
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
High School Diploma or GED required
Associates degree preferred; Education in Legal Studies preferred; Bachelors in legal studies desired
Minimum Related Work Experience:
3 years' relevant experience. OR 1 year of HMS experience and 2 years of relevant experience
Experience in a Legal office a plus; paralegal or legal assistant and/or experience in the insurance industry (casualty or health insurance) a plus
Knowledge of Microsoft Word and Excel required.
Basic knowledge of Microsoft Access preferred.
Medicaid and/or Medicare knowledge preferred.
Bilingual (Spanish & English) a plus.
Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.