Salary: 19.570-25.890 :USD

State of New Hampshire Job Posting

Department of Health and Human Services

Bureau of Program Integrity- Third Party Liability

Concord, NH

MEDICAL SERVICE TECHNICIAN

#TMPPT4614- Part-Time (29.5 hrs/week)

The starting pay range for this position is $19.57-$25.89 hourly

YOUR EXPERIENCE COUNTS - Under a recent change to the rules, an applicant's relevant experience now counts towards formal education degrees referenced in the posting See Per 405.1.

18 Months of additional relevant experience = Associate's degree

36 Months of additional relevant experience = Bachelor's degree

54 Months of additional relevant experience = Master's degree

The State of New Hampshire, Department of Health and Human Services, Bureau of Program Integrity has a part time vacancy for Medical Service Technician.

SUMMARY:

Carry out Third Party Liability policies and procedures in accordance with federal regulations for the New Hampshire Medical Assistance Program.

RESPONSIBILITIES:

Investigates potential third party liability cases, referred and identified by many sources, to identify medical services appropriate for health insurance coverage, to update information systems data on eligible claims, and to recover funds from third party resources.

Researches medical claims, data files, eligibility information, insurance coverage, and NH medical assistance policies to determine liability for medical services payment, to make payment or denial on medical claims, and to authorize third party billings to insurance carriers.

Reviews and compares data exchange material and computer generated data of recipient third party information with the recipient medical history file in order to verify and update third party information and to recover funds expended when a third party payor is responsible.

Reviews and validates insurance company payment denials and obtains necessary data to correct and resubmit claims for payment.

Modifies and maintains recipient third party liability system files within our Medicaid Management Information System in order to identify system program actions to pay or deny claims properly.

Interprets and explains State laws, department rules and department policy in contacts with recipients, absent/custodial parents, district offices, medical providers, employers, insurance carriers, attorneys and other professionals. Provides training and support to department staff.

Makes extensive use of data base applications, information systems, and on-line access to external files for investigations, research, verification and recovery of third party resources.

Assists other TPL staff with Health Insurance Premium Payment (HIPP) processing and Medicaid for Employed Adults with Disabilities (MEAD) processing.

Establishes and maintains relationships with other State Agencies, departments and staff to coordinate policies and procedures to identify potential third party resources. Makes recommendations to the proper authorities for fraud referral or legal action to recover medical expenses.

MINIMUM QUALIFICATIONS:

Education: Associate's degree, or its equivalent, from a recognized college or technical school with a major study in a health, medical or paramedical field, information systems, or finance. Each additional year of approved formal education may be substituted with one year of required formal education.

Experience: Four years' paraprofessional experience at the level of a case aide, case technician, or related field. Each additional year of approved work experience may be substituted for one year of required formal education.

PREFERRED QUALIFICATIONS: Prefer experience in finance, collections, billing/receivables and/or computer systems. Prefer knowledge of the Medicaid Program and/or medical claims and payment processing. Ability to exercise judgment and make decisions based upon fact gathering information in accordance with division policy.

DISCLAIMER STATEMENT: The supplemental job description lists typical examples of work and is not intended to include every job duty and responsibility specific to a position. An employee may be required to perform other related duties not listed on the supplemental job description provided that such duties are characteristic of that classification.

For further information please contact Nancy Jefferson, Supervisor VI, Nancy.J.Jefferson@DHHS.NH.GOV, 603-271-8063.

EOE

TDD Access: Relay NH 1-800-735-2964