Medical Treatment Adjudicator 3- CP91 (HQ)

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profile Job Location:

Tumwater, WA - USA

profile Monthly Salary: $ 4216 - 5666
Posted on: 23-10-2025
Vacancies: 1 Vacancy

Job Summary

Description



Medical Claims Processor/Medical Treatment Adjudicator 3
Full-Time Permanent
Location: Headquarters Tumwater WA
Salary Range: $4216-$5666 Monthly
The Department of Corrections is seeking a highly motivated and qualified individual to take on the dynamic role of Medical Treatment Adjudicator 3 Medical Claims Processors for our HS Contracts Claims & Benefits Unit within the Health Service Division. This is a permanent position located at Department of Corrections Headquarters in Tumwater Washington.

Medical Claims adjudicator in the claims section of the Statewide Health Services Contracts Claims and Benefits Unit (HSCCBU). This position contributes to the Departments mission by ensuring timely and accurate adjudication of claims for medical services provided to community violators and incarcerated individuals. This position helps ensures that relationships between contracted community health services providers and the Agency are in good standing through timely adjudication of claims for services. At the expert level independently adjudicates claims for medical services submitted to DOC both through the Provider One (P1) system for incarcerated individuals and the standard manual paper process for community violators by deciphering and interpreting information on claims/adjustment requests within DOCs internal systems polices and protocols to arrive at a determination of either processing or denial of providers claims

To be considered for this position please attach the following to your online application:
  • A detailed chronological resume and
  • Letter of Interest that outlines how you meet the qualifications for this position
Application assessment will be ongoing and the hiring authority reserves the right to offer the position at any time during the recruitment process. It is to the applicants advantage to apply as early as possible.

This recruitment could be used to fill multiple permanent or non-permanent positions.

Duties

Key responsibilities of this Medical Treatment Adjudicator 3 Medical Claims Processor include but are not limited to:

  • Independent adjudication of claims to determine appropriateness for processing or denial of claims for medical services provided to DOC community violators and incarcerated individuals both on and offsite prison grounds and in local jail facilities by thoroughly assessing if items billed were; authorized by the Department are in compliance with the WA DOC Health Plan WDHP and Heath Services policies/protocols have been submitted per contract terms are priced according to the fee schedules in place as of the date of service and are from a contracted provider both utilizing the P1 system and various internal data systems.
  • Understand and apply contractual payment terms to adjust and compute appropriate payment for items billed based on established reimbursement methodologies.

    Provide excellent reporting and customer service for all stakeholders; collaboration with unit sections on related tasks completion and submission of Medicaid applications for IP event and timely tracking and follow-up of any issues that affect claims adjudication.
  • Other Duties as assigned.

Qualifications

Required:

  • One year of experience as a MedicalTreatment Adjudicator 2 or equivalent.
  • Recent experience in medical claims processing billing adjusting and/or investigation related work in the area of health insurance; other medical premiums/claims related experience may substitute year for year for the required experience.
  • Knowledge and understanding of various health care coding structures (CPT HCPCS ICD-9 ICD-10 etc.)
  • Proficiency with Microsoft Excel and Outlook

Preferred:
  • Intermediate/Advanced skills with Microsoft Excel Access and Outlook
  • Experience adjudicating various claim types in the ProviderOne System
  • Certified Medical Coder

Supplemental Information

Mission: The mission of DOC is to improve public safety by positively changing lives.

Our Vision: Working together for safer communities.

Our Commitment: To operate a safe and humane corrections system and partner with others to transform lives for a better Washington.


Our Core Values:


  1. Cultivate an environment of integrity and trust:Corrections values partnership and trust. We foster openness and support courageous conversations. We are committed to doing what we say we are going to do by being accountable and taking personal ownership in our actions.
  2. Respectful and inclusive interactions:Corrections appreciates and values individuals by promoting an inclusive and diverse environment which encourages safety. We respect value and listen to the thoughts feelings and perspectives of our stakeholders and consider the impact on those we serve as well as each other.
  3. Peoples safety:Corrections believes in creating an environment that values physical mental and emotional security and well-being. We honor those who advance safety for all.
  4. Positivity in words and actions:At Corrections we assume positive intentions and believe there is a shared desire for the best outcome. We consistently demonstrate positive behavior and always put forth our best effort.
  5. Supporting peoples success:Corrections is committed to our community understanding individuals instilling hope embracing change and providing opportunities.


IMPORTANT NOTES:

  • Please include a minimum of three (3) professional references with your application. A professional reference is defined as an individual who has been paid to supervise your work and can attest to your work performance technical skills and job competencies. If you do not have any or sufficient professional references please include non-related professionals such as educators or other professional associates.


**Please note: Phone number AND email address are required for all professional references.

  • A background check including criminal record history will be conducted prior to a new hire. Information from the background check will not necessarily preclude employment but will be considered in determining the applicants suitability and competence to perform in the position.
  • Employees may work directly with or near incarcerated individuals in a potentially hazardous setting. Please consider this when deciding whether to apply.
  • We are committed to maintaining a drug and alcohol-free work environment and our employees are expected to comply with all state and federal laws. A pre-employment drug test may be administered as part of the selection process and applicants who test positive for any controlled substances will be disqualified from consideration.
  • Oleoresin Capsicum (OC) is an aerosol pepper spray made available as a means of self-defense and/or de-escalation. Applicants with sensitivities or allergies are encouraged to ask about the level of exposure they could expect in this position.
  • Animal care projects are a common component of most Washington State prisons including dog and cat programs. Applicants with animal sensitivities or allergies are encouraged to ask about the level of exposure they could expect in this position.
  • Tuberculosis (TB) is a priority health issue for DOC employees. The successful candidate may be required to provide valid proof of a baseline TB skin test within 60 days from thedate ofhire. When positive tests result further information testing and treatment will also be required. Employment is not contingent upon test results.
  • This position may be represented by a bargaining unit.
  • Requires respirator medical evaluation questionnaire fit testing training and use of respiratory protection as required by the WA Industrial Safety & Act standards. Refer to WAC 296-842 to learn more.
  • Must be able to work in spaces climb stairs walk long distances and frequently lift up to 30 pounds. Under rare circumstances this position may be required to lift or carry up to 50 pounds and push up to 100 pounds.
  • Foreign equivalent degrees awarded outside the United States must have a credential evaluation report attached to your application. You may request the required evaluation/documentation from and. Until this documentation is provided you will not be selected to move forward in the hiring process.
  • Candidates who are offered a job with the Department of Corrections must possess work authorization that does not require sponsorship by the employer for a visa now or in the future.
  • (FOR RN POSITIONS)Salary is based on experience and is determined at the time a final offer of employment is made. The salary range listed in the job posting includes Steps A-U. Step U is a longevity step and is typically gained six years after being assigned to Step T in your permanent salary range.
  • (FOR ALL OTHER NON WMS POSITIONS)Salary is based on experience and is determined at the time a final offer of employment is made. The salary range listed in the job posting includes Steps A-M. Step M is a longevity step and is typically gained six years after being assigned to Step L in your permanent salary range.
  • DOC complies with the employment eligibility verification requirements for 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. does not use E-Verify; therefore we are not eligible to extend STEM-Optional Practice Training (OPT). For information please visit.


We are committed to hiring individuals who possess core diversity competencies:

Foster a positive attitude and openness toward the ever changing social and cultural makeup of the workplace.


  • Work effectively with people of different perspectives abilities disabilities races religions ages lifestyle preferences and social ethnic and cultural backgrounds.
  • Respectfully acknowledge peoples differences and recognize these differences as important and valuable.
  • Promote inclusiveness.
  • Be culturally sensitive and appropriate.
  • Respect and value diverse backgrounds and traditions.


What We Offer:


As an employee of the Department of Corrections your work-life integration is a priority. Washington State employees are offered one of the most inclusive and competitive benefits packages in the nation. Besides comprehensive family insurance for medical dental and vision these perks also may include:


  • Up to 25 paid vacations days a year
  • 8 hours of paid sick leave per month
  • 12 paid holidays a year
  • Generous retirement plan
  • Flex Spending Accounts
  • Dependent Care Assistance
  • Deferred Compensation and so much more!


Many DOC jobs are covered by the Public Safety Employees Retirement System (PSERS). If someone moves from a Public Employees Retirement System (PERS) eligible position to a PSERS eligible position they actually retire under two different systems/plans. For more information please contact the Department of Retirement System at: 1-.

DOC is an equal opportunity employer and does not discriminate on the basis of race creed color national origin sex marital status sexual orientation gender identity gender expression age honorably discharged veteran veteran status genetic information or the presence of any sensory mental or physical disability or the use of a trained guide dog or service animal by a person with a disability.


For questions about this recruitment or to request reasonable accommodation in the application process pleaseemailor call at .

For TTY service please call the Washington Relay Service at 7-1-1 or 1-.


DescriptionMedical Claims Processor/Medical Treatment Adjudicator 3Full-Time PermanentLocation: Headquarters Tumwater WASalary Range: $4216-$5666 MonthlyThe Department of Corrections is seeking a highly motivated and qualified individual to take on the dynamic role of Medical Treatment Adjudicator 3...
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Key Skills

  • Clerical
  • English Language
  • Administration
  • Compliance
  • Investigative reports
  • SSA
  • AS400
  • Critical thinking
  • CMS
  • Computer Operating
  • Mathematics
  • Medicine
  • Customer and Personal Service
  • Personnel Security
  • Safety and Security