Medical Treatment Adjudicator I

Title: L&I Medical Treatment Adjudicator 1

Location: Tumwater United States

Salary

$42,972.00 - $57,240.00 Annually

Location 

Thurston County – Tumwater, WA

Job Type

Full Time - Permanent

Remote Employment

Flexible/Hybrid

Job Description:

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&I's Insurance Services' Health Services Analysis program is seeking multiple Medical Treatment Adjudicator 1's 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, RCW's and WACs.  This position directly supports our agency's 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 Washington's workers. We help employers meet safety and health standards and inspect workplaces when alerted to hazards. As administrators of the state's 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 260,000 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 Washington's 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 (4/10's, 9/80's, 5/8's, 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.

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.
• 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 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.

Did You Know?

Washington is America's 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.

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 agency's 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.