L&I Medical Treatment Adjudicator 1

Our Mission:Keep Washington Safe and Working!
Our Values: Customer Focus One L&I Respect Diversity Equity and Inclusion Learning and Growth Reliability

Please Note: This announcement represents multiple permanent opportunities.

Job Highlights

Are you ready to use your communication and customer service skills in a way to help medical professionals provide injured workers treatment Do you enjoy complex problem-solving and research

L&Is Insurance Services Health Services Analysis program is seeking multiple Medical Treatment Adjudicator 1s to report to a Medical Treatment Adjudicator Supervisor within the Medical Bill Payment Unit.

In this position you will be responsible for all aspects of caseload management in accordance with established production and timeliness standards. This includes ensuring timely and accurate bill payments and delivering high quality customer service to external and internal stakeholders. Additionally you will provide consultative services to medical other providers and/or department staff regarding bill payment policies and procedures RCWs and WACs. This position directly supports our agencys mission to Keep Washington safe and working by processing payments for medical and other services to assist in returning injured and ill workers to work.

What we are looking for:

• Strong interpersonal verbal and written communication skills.
• Ability to access and move between multiple computer programs.
• Ability to present complex information to a wide variety of audiences in a way that is easy to understand.
• Detail-oriented and able to develop effectively prioritize and maintain a highly organized work environment.
• Demonstrated ability to research problems compile and audit data.

Why Work for us:

The Department of Labor & Industries (L&I) is a diverse state agency dedicated to the safety health and security of Washingtons workers. We help employers meet safety and health standards and inspect workplaces when alerted to hazards. As administrators of the states workers compensation system we are similar to a large insurance company providing medical and limited wage-replacement coverage to workers who suffer job-related injuries and illness. Our rules and enforcement programs help ensure workers are paid what they are owed that children and teens work hours are limited and that consumers are protected from unsound business practices.

Insurance Services is the largest division within the agency and administers one of the premier workers compensation organizations in the nation serving over 3.8 million employees working for 260000 employers.

The Health Services Analysis Program Medical Bill Payment (MIPS) unit provides bill payment adjudicative and consultative services to internal and external customers including medical providers workers and/or department and agency staff.

Some of what you will do:

• 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.
• Make 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.
• Assist 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!

Required:

• 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.

Desired:

• Experience in medical billing that involves coding including knowledge of:
  • International Classification of Diseases (ICD-10)
  • Current Procedural Terminology (CPT)
  • Healthcare Common Procedure Coding System (HCPCS)
  • All Patient Refined Diagnosis Related Groups (APR-DRGs)

Things You Need To Know

At L&I your voice matters. L&I is a diverse state agency dedicated to the safety health and security of Washingtons 3.3 million workers. Watch this brief video and learn more about why L&I is an employer of choice.

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. Click on the Benefits tab to learn more.

We value our employees and their work-life balance. We support a hybrid work model and offer flexible custom work schedules. This position is eligible for a flexible schedule (4/10s 9/80s 5/8s etc.) upon approval by management. For positions where in office work is necessary the frequency of telework will be discussed with the supervisor of the position at the time of offer.

For this position you will be expected to work in office at least once a week during the training period. Upon completion of the training period telework is permitted full time with the expectation to come to the office for meetings training or upon business needs. The assigned duty station for this position is Tumwater Washington.

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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:

1. A cover letter describing specific qualifications.
2. A current resume detailing applicable experience and education.
3. 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. If you would like to read our website in a language other than English scroll up to the top of the page to select your language of choice from the banner.

Background Check Notice

Prior to a placement in this position a background check including criminal history records will be conducted. Information from your background check will not necessarily preclude employment but will be considered in determining your eligibility to perform the requirements of the position.

Other information

• Applicants selected to move forward in the hiring process will be contacted to schedule a skills assessment. Assessments are conducted in person in our Tumwater Headquarters office.
• For positions requiring travel you must have a valid unrestricted drivers license and have insurance if driving a privately owned vehicle on state business.
• This position is represented bytheWashington 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.

Did You Know

Washington is Americas Top State to live play and work according to U.S. News (2021). Join the L&I team and enjoy all the Evergreen State has to offer.

Veterans Preference

Applicants wishing to claim Veterans Preference should attach to their application a copy of their DD-214 (Member 4 copy) NGB 22 or signed verification of service letter from the United States Department of Veterans Affairs. Please blackout any personally identifiable data such as Social Security numbers. For further information contact L&Is .

Diversity Equity and Inclusion Employer

L&I employees come from all walks of life. We strive to hire great people from a wide variety of backgrounds. All qualified applicants will receive consideration for employment without regard to race color religion gender gender identity or expression sexual orientation national origin genetics disability age or veteran status.

We believe in the importance of recognizing the value each of us contributes to the success of the agency mission. Having a diverse workforce is this agencys greatest source of strength and knowledge. It is through the combination of talents and abilities that we can pursue finding effective measures to provide the best customer service. We are committed to building a diverse and inclusive workplace for everyone and we strongly mean everyone.

The State of Washington is an equal opportunity employer. Persons with a disability who need an accommodation in the application process or testing process or those needing this announcement in an alternative format may call . TTY users should first call 711 to access the Washington Relay Service.

You are welcome to include the name and pronoun you would like to be referred to in your materials and we will honor this as you interact with our award-winning diverse and inclusive organization.

For more Information

If you have any questions regarding this job posting program or the agency please contact Angela Laramie at .