Job Description

Job Description

**This fully-remote role is open to WI residents ONLY!
** This is a long-term temporary position, set to run through 2025!

Spherion Staffing & Recruiting, in partnership with the State of Wisconsin, is recruiting a Medicaid Services Claims Examiner, which operates under close supervision of the Lead Katie Beckett Disability Determination Examiner and general supervision of the Clinical Policy Section Manager. This position is predominantly responsible for serving as an adjudicator for Katie Beckett Disability Determinations. This includes the ability to document and determine disability entitlement under Social Security Disability Act, Amendments, and Regulations in both paper and electronic format. Effective caseload management in both an electronic and paper environment along with decisional accuracy and timeliness of decisions are significant aspects of this position. Extensive reading and work with electronic medical and evidentiary records is required.

The Medicaid Services Claims Examiner evaluates and adjudicates a mix of initial, continuing, and appellate level Katie Beckett Disability Determinations. This position requires clinical experience in multiple settings of varying complexity and experience with children populations. The Examiner maintains the capability and flexibility to process a variety of disability claims efficiently, accurately, and timely.

The Medicaid Services Claims Examiner is responsible for maintaining their own fluency and awareness of best practice expectations within their treatment modality and maintains professional currency through participation in continuing education.

Submit your resume for this position today!

Responsibilities:

• Determine disability in Continuing Disability Review claims at both the initial and appellate level regarding the Clinical Policy Sections, Katie Beckett Disability Determination
• Review evidence and decisional information on a previously allowed case
• Determine proper jurisdiction and the type of disability determination required. Identify the comparison point decision (CPD), using the Social Security Administration (SSA) query system, case file and other resources
• Contact SSA for prior file location and status as necessary (if available)
• Develop evidence in a timely fashion by utilization of proper standardized forms, telecommunications, or other means. This will involve extensive use of computer applications
• Identify need for additional medical data not available from established records
• Assess medical listings and functional equivalence as appropriate
• As required by regulations, evaluate the medical and non-medical findings and statements to determine domain limitations in child reviews
• Prepare written requests for reviews, including a summary of relevant information and specific issues to be addressed
• Adjudicate specialized disability case types or case issues as needed, such as blindness entitlement, failure to cooperate and medically necessary treatment
• Respond to Congressional Inquiries, Release of Information requests, Privacy Act or Freedom of Information requests according to prescribed regulations, agency protocols, and within required timeframes
• If consultation is needed, confer with supervisors or other disability program specialists to assist in resolving complex programmatic and other technical assessment issues
• Make final determination of ongoing disability by applying the disability regulations. In continuances, determine the re-exam diary date
• Electronically prepare documentation of the decision including the appropriate completion of standardized documents and proper written notification to claimants and beneficiaries

Required Skills:

• Thorough knowledge pertaining to Katie Beckett Disability Determination of the Social Security Act and Amendments
• Comprehensive knowledge of all phases of disability claim adjudication and knowledge of specific substantive and technical requirements of claim adjudication at all levels
• Thorough knowledge of medical aspects of disability evaluation including medical terminology, advances in medical technology, disease processes, medical tests, diagnostic and treatment practices and the functional limitations resulting from physical and mental impairments
• Thorough knowledge of the regulations governing the release of information according to the Privacy Act, Freedom of Information Act and HIPAA rules and regulations
• Knowledge of Bureau workflow, organization, and operational procedures
• Ability to analyze material, recognize discrepancies, and come to logical and objective conclusions with regards to established policies, procedures, standards, regulations and agency quality criteria
• Ability to work collaboratively with examiners, supervisors and medical consultants to resolve issues and differences of opinion

Preferred Skills:

• Ability to identify priorities and work independently while effectively managing and consistently processing diverse disability caseloads, both timely and accurately
• Ability to research and solve problem issues and communicate potential solutions to appropriate individuals
• Ability to communicate clearly and effectively, both orally and in writing, as well as the ability to adjust communication level to the appropriate audience

Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Spherion, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact Callcenter@spherion.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Spherion offers a comprehensive benefits package, including health, and an incentive and recognition program (all benefits are based on eligibility).

For certain assignments, Covid-19 vaccination and/or testing may be required by Spherion's client or applicable federal mandate, subject to approved medical or religious accommodations. Carefully review the job posting for details on vaccine/testing requirements or ask your Spherion representative for more information.

Company Description

Since 1946, Spherion has placed millions of talented individuals in rewarding administrative, clerical, light industrial, customer service, non-clinical healthcare and professional jobs. Filling a broad mix of flexible, temp-to-hire and direct hire positions, Spherion is a trusted recruiting and staffing partner to more than 3,000 companies nationwide.

Company Description

Since 1946, Spherion has placed millions of talented individuals in rewarding administrative, clerical, light industrial, customer service, non-clinical healthcare and professional jobs. Filling a broad mix of flexible, temp-to-hire and direct hire positions, Spherion is a trusted recruiting and staffing partner to more than 3,000 companies nationwide.