Medicaid Third Party Liability Analyst

Make a Difference with DHSS

Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas.

We offer numerous career opportunities and are dedicated to attracting and retaining highly talented individuals who are ready to make a difference in their community today. DHSS is a great place to kick-start your profession.

For more information, please visit https://dhss.delaware.gov/dhss/ today!

The Third Party Liability Analysts operate to ensure Medicaid is the payer of last resort. Medicaid is mandated by the federal government to pursue cost avoidance and pay and chase third party carriers through this process. Analysts accomplish this by responding to various third party liability (TPL) lead sources. Review and analyze data to determine eligibility for TPL services. The position receives insurance leads from various sources, contacts insurance carriers via phone and/or internet to verify the information and updates the data into our Medicaid system to both cost avoid paying claims and allow the clients to get claims paid as needed.

Analyst also receives Medicare leads. Using the information that was obtained to access the Medicare data base (CMS/MarX) which contains Medicare parts A, B, C, & D. This information helps to determine client eligibility. TPL analysts read, analyze, and interface the data that is provided on the various Medicare screens. Analysts will distinguish between the various Medicare plans, such as a Delaware Medicare plan and an employer sponsored plan.

Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.

• Reviews claims of Medicaid recipients to establish and collect Third Party Liability reimbursement. 
• Implements established procedures to recover program funds where Third Party Liability sources have been determined.
• Investigates and monitors processing system of recovery in compliance with Medicaid Third Party Liability policy, assignment and subrogation laws, statutes of limitations and various claims processing systems. 
• Conducts post-payment reviews of paid claims through interpretation of histories and accomplishes recoveries of major medical expenditures. 
• Establishes measures to identify and verify third party resources to support cost-avoidance, recovery of funds and implementation into the DHSS DCIS/Pact institutional billing system.
• Maintains accurate up-to-date third party liability files and data on eligible medicaid recipients for entry into computerized system.

  JOB REQUIREMENTS for Medicaid Third Party Liability Analyst
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

1. Six months experience in benefits claims processing such as health, dental, or life.
2. Six months experience in interpreting laws, rules, regulations, standards, policies, and procedures.
3. Six months experience in using an automated information system to enter, update, modify, delete, retrieve/inquire and report on data.
4. Six months experience in narrative report writing.
5. Knowledge of health care reimbursement which includes reviewing and categorizing claims for proper billing, analyzing cost reports, examining cost containment, and interpreting and analyzing laws, rules, regulations, policies, procedures and standards affecting reimbursement and recovery.

This position is a classification organized under an exclusive bargaining representative (labor organization) that has been elected by employees as their representative for collective bargaining and other applicable terms and conditions of employment, in accordance with Title 29, Chapter 59 and Title 19, Chapter 13 and 16.  This position is covered by a collective bargaining agreement based on its individual terms.

Applicants must be legally authorized to work in the United States. The State of Delaware participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. For more information refer to our Job Seeker Resources.

DHSS does not provide employment-based sponsorship.

To learn more about the comprehensive benefit package please visit our website at https://dhr.delaware.gov/benefits/

The application and supplemental questionnaire are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position.  It is essential that you provide complete and accurate information on your application and the supplemental questionnaire to include dates of employment, job title and job duties.  For education and training, list name of educational provider, training course titles and summary of course content.   Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment, education and training history as it relates to the job requirements.

Once you have submitted your application on-line, all future correspondence related to your application will be sent via email.  Please keep your contact information current.  You may also view all correspondence sent to you by the State of Delaware in the “My Applications” tab at StateJobs.Delaware.gov.

Accommodations are available for applicants with disabilities in all phases of the application and employment process.  TDD users may request an auxiliary aid or service by calling (800) 232-5470 or by visiting delawarerelay.com.  You may also call (302) 739-5458 or email DHR_ADAConcerns@delaware.gov for additional applicant services support.

The State of Delaware is an Equal Opportunity employer and values a diverse workforce. We strongly encourage and seek out a workforce representative of Delaware including race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression.