Under the general direction of the Specialty Programs Unit Manager, the Specialist II serves as a resource to the Center for Healthcare Financing (CHCF) staff primarily in matters concerning estate recovery. This individual will ensure the integrity of collection outcomes, according to federal and state estate recovery regulations.
Responsibilities
MAJOR RESPONSIBILITIES:
Continue to refine and enhance current operations, implementing innovative methods to identify new cases, verify claims and recover payments originally paid by Medicaid and/or other state funded programs based on federal and state statutes and regulations.
Research, maintain and understand compilation of all Federal and State statutes and regulations pertaining to Third Party and Estate Recovery to ensure Medicaid is the payer of last resort.
Maintain a caseload as assigned, following established protocols
Identify benefits paid by Medicaid and calculate the total value to be recovered in each case.
Represent the best interest of the Medicaid program consistent with the goals and objectives of CHCF
Request and produce claims history printouts including all service reports from Medicaid history databases for recipient payment history.
Investigate and document all case related matters and relevant financial and medical history in order to support a claim against the probate estate or third party settlements of a Medicaid member.
Provide training of support staff
Maintain and update Recovery training manual
Maintain all case records as required for an established time period
Communicate and collaborate with probate courts, attorneys, hospitals, insurance companies and other relevant entities to insure all Medicaid related Estate Recovery cases are referred to the unit and processed accordingly
Conduct legal research through the use of public databases and web based applications and prepare legal memoranda and other case related documents for referral to Medicaid EHS legal department.
Research record of ownership and title of real estate at the Registry of Deeds
Perform other job related duties as required or assigned
Qualifications
REQUIRED QUALIFICATIONS:
Bachelor’s Degree in Business Administration or equivalent experience
3 years related experience
Paralegal certificate
Strong oral and written communication skills
Knowledgeable of Massachusetts Statutes as it relates to Estate Recovery
Understanding of Medicaid regulations as they govern eligibility requirements
Proficient in Microsoft Office, web based solutions and scanning software
Effective negotiation skills
PREFERRED QUALIFICATIONS:
Third Party Recovery or collections experience
Paralegal degree
Proficient in Probate and Real Estate Law, Wills and Trusts, Chain of title research and insurance regulations pertaining to Medicaid qualifying annuities.
Possess a thorough understanding and knowledge of the state and federal laws and the procedures relating to the recovery of medical assistance for members receiving Medicaid benefits.
Previous experience communicating professionally and effectively with Board of Hearings (BOH) personnel, enrollment centers staff and managers, family and/or legal representatives of Medicaid members and the general public.
Ability to track and organize the recording of Medicaid liens in Registry of Deeds
Understand HUD settlement statements, state and federal taxes, appraisals, priority of liens and creditors, comparative market analysis, and probate-related appointments
Additional Information
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