L&I Medical Treatment Adjudicator 1

Description

Our Mission: Keep Washington Safe and Working!

Our Values: Customer Focus, One L&I, Respect, Diversity, Equity and Inclusion, Learning and Growth

Job Highlights

If you enjoy complex problem-solving and research, and are ready to use your communication and customer service skills to help medical professionals provide injured workers’ treatment, this opportunity might be right for you.

Duties

• Effectively maintain a unit caseload and accurately adjudicate bills within established time standards.
• Interpret and resolve billing problems according to the Industrial Insurance Act, department policies, and the Medical Aid Rules and Fee Schedule.
• Made determinations regarding allowance, rejection or adjustment of bills based on the medical data in the file, the nature of the injury and the legal status of the claim.
• Correct specific billing problems on-the-spot in order to prevent re-billing.
• Process adjustments on previously adjudicated bills and take deductions for overpayments or payments made in error.
• Professionally explain and communicate billing procedures, coding criteria and departmental policies to internal and external customers.
• Respond to written and telephone inquiries from injured workers, attorneys, health care providers and vendors.
• Return denied bills with written explanation of reasons for denial.
• Aid Claim Managers and other departmental staff in resolving protests from injured workers, attorneys, hospital administrators, physicians and others who may be challenging departmental bill payment decisions, by researching and compiling the necessary data.
• And much more!

Qualifications

• Graduation from high school.
• AND Two (2) years’ experience involving work with industrial insurance claims or in processing financial records such as accounts receivable, payrolls, bill payment, claims adjusting, military medical corpsman, medical social worker, or closely related field.
• *Additional college or business school education may be substituted year for year for required experience.

Supplemental Information

• At L&I, your voice matters. L&I is a diverse state agency dedicated to the safety, health and security of Washington's 3.3 million workers.
• L&I provides a modern work environment and excellent benefits including paid leave, tuition reimbursement, Infants at Work Program and a generous retirement package for qualified employees at the end of their career.
• We value our employees and their work-life balance. We support a hybrid work model and offer flexible custom work schedules.
• To receive more information on opportunities at L&I sign up for GovDelivery and select L&I job alerts.
• Application process - We will contact the top candidates directly to interview for this position. Because we base the selection on information provided by you, it is in your best interest to identify the knowledge, skills, and abilities that address the required and desirable qualifications described in the announcement.
• Please include the following documents with your application: A cover letter describing specific qualifications, a current resume detailing applicable experience and education, and a list of at least three professional references with current telephone numbers.
• Please do not attach or place any medical information (vaccination status included) within the application, resume, or cover letter. If you do, we will have to reject your application to safeguard others from receiving your confidential information. You will have to remove the confidential information before you can apply again.
• To learn more about our hiring process timeline at L&I please visit our L&I recruiting page at Hiring Process at L&I.
• For positions requiring travel, you must have a valid unrestricted driver's license and have insurance if driving a privately owned vehicle on state business.
• This position is represented by the Washington Federation of State Employees (WFSE).
• Candidates who are offered a job with L&I must possess work authorization that does not require sponsorship by the employer for a visa now or in the future.
• The Department of Labor & Industries complies with the employment eligibility verification requirements of the federal employment eligibility verification form, I-9. The selected candidate must be able to provide proof of identity and eligibility to work in the United States consistent with the requirements of that form on the first day of employment.
• Please note: L&I may use this announcement to fill multiple permanent and/or non-permanent positions.