Third Party Liability (TPL) Recovery Officer (05141, 08159)

State of Montana - Helena, MT

Full-time - Entry Level

Remote - Helena, MT

Executive, Legislative, and Other General Government Support

About the position

The Montana Department of Public Health and Human Services (DPHHS) has a career opportunity within the Office of Inspector General, Program Compliance, Third Party Liability Unit. This position works as part of a team that identifies, negotiates, and collects funds from liable third parties, estates, and public assistance members to ensure the integrity and cost-effectiveness of programs administered by the department. Responsibilities include examination of paid claims, contacting appropriate parties for information, calculating liability and financial recovery. Other responsibilities include tracking and reporting recovery funds into software systems, filing claims and liens, negotiating settlements, and determining the cost effectiveness of Medicaid members having private insurance via the Health Insurance Premium Program (HIPP).

Responsibilities

• Examine paid claims and contact appropriate parties for information.
• Calculate liability and financial recovery.
• Track and report recovery funds into software systems.
• File claims and liens.
• Negotiate settlements.
• Determine the cost effectiveness of Medicaid members having private insurance via the Health Insurance Premium Program (HIPP).

Requirements

• General understanding of the Medicaid program including public assistance eligibility, claims processing, cost-avoidance functions, and insurance resources.
• Interpersonal, oral, and written communication skills and techniques.
• Ability to gather, verify, and analyze claims and financial data.
• Ability to use reason and logic to identify and solve problems.
• Bachelor's degree in social sciences, accounting, healthcare, business or related degree.
• Two years of experience with health care reimbursement, analyzing cost reports, interpreting and analyzing laws, rules, regulations, and standards affecting reimbursement and recovery.

Nice-to-haves

• Equivalent combinations of directly related education and experience may be considered on a case-by-case basis.

Benefits

• Healthcare coverage
• Retirement plans
• Paid vacation
• Sick leave
• Holidays
• Work/life balance
• Eligibility to participate in the Public Service Loan Forgiveness (PSLF) program
• Wide range of advancement opportunities.