Definition

In the Division of Disabilities Determination Services (DDS) these positions work under general supervision and provide routine technical support to DDS Adjudicators by planning, coordinating, and completing case processing actions for Social Security Disability Insurance. These positions receive training and on-the-job experience using Social Security Administration (SSA) and Community Services Office (CSO) electronic case files and SSA regulations to provide technical assistance to adjudicative staff and use specialized State and Federal computer programs and data bases to complete case processing tasks unique to DOS. These positions are the first point-of-contact for medical providers and have limited authority to make decisions on medical records attainment based On SSA regulations. Complex and unusual problems are presented to higher level staff for resolution.

Distinguishing Characteristics

This is the entry level of the series. Positions have a limited scope and work toward increased independence to provide the full range of services through formal DDS training and on-the-job training. The majority of the time is spent completing routine duties in support of DDS Adjudicators. These positions provide a variety of routine technical computer, case file, and lower-level adjudicative tasks such as coordinating and attaining records using specific knowledge-of and adherence to SSA regulations on records retention, management of different types of records, and correct placement of records in the electronic case file.

Typical Work

Evaluates documents for accuracy, ensures proper regulatory attachments are available, and determines method of delivery;

Has responsibility for the security and handling of confidential protected information.  Independently verifies the routing of medical records and other confidential paper and/or electronic records received for claims decisions.  Ensures documents are complete and associated with the correct claim; 

Screens and verifies identity information, provides claim status:

Assists claimants in understanding the Social Security Disability program requirements; redirects calls if necessary;

Opens, prioritizes, and sorts incoming mail for all staff and for claims processing; collects and provides technical review of outgoing mail by destination and type; logs all cash receipts; ensures medical billing statements are separated and entered into the electronic claim for payment processing;

Arranges for confidential medical records and reports to be sent or released to consultative examination vendors, attorneys, or other authorized third parties; 

Researches the AS400 database and SSA eView, creates paper case files for claims adjudication, verifies receipt, and determines accurate fee reimbursement; 

Verifies and processes payments for Medical Evidence of Record for ODDS offices; reminds claimants of appointments and program requirements; 

Processes and follows up with external state partners for vendor registration; coordinates and performs archiving duties;

Performs other duties as required.

Legal Requirement(s)

There may be instances where individual positions must have additional licenses or certification. It is the employer's responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Background Checks are required by the Social Security Administration.

Desirable Qualifications

Two years of college-level coursework and one year of experience working with disability, medical or health insurance claims adjudication or investigation, or closely related field.

Additional education or experience may substitute year for year for the desirable education and experience qualifications.

Class Specification History

New class; adopted June 30, 2015; effective July 1, 2015.