Definition

In the Division of Disabilities Determination Services (DDS) these positions independently provide technical support coordinating, and completing case processing actions for DDS Adjudicators for determinations for Social Security Disability claims. They are the first point-of­contact for applicants and medical providers and have authority to make decisions on medical records attainment based on SSA regulations, authorization and bill paying, scheduling, and completing technical case actions utilizing specialized State and Federal computer programs and databases.

Distinguishing Characteristics

This is the fully qualified journey level of the series. Positions make decisions independently regarding claim information and coordination of required evidence with federal and state partners, the professional community, attorneys, and applicants. Responsible for casework and/or own workload management and meeting deadlines. Positions continue to participate in advanced formal and on-the-job training.

Typical Work

Reads and interprets Social Security regulations and procedural manuals;

Obtains and reviews necessary data, documentation, and verification of documentation as it relates to the recipients' specific circumstances; explains program requirements to applicants;

Evaluates claim downloads from Social Security Field Offices and DSHS offices and accepts or rejects jurisdiction; ensures accurate claim information is received and transmitted back to Social Security Administration;

Contacts state and federal partners, professional organizations, attorneys, applicants, and third parties to resolve discrepancies or obtain additional information;

Coordinates contracted medical and psychological providers' schedules, schedules appointments, transportation, and interpreters for applicants;

Monitors report receipt and authorizes payment for services using knowledge and understanding of Current Procedural Terminology (CPT) codes; accurately prepares fiscal documents;
Researches federal databases and verifies receipt, determines accurate fee reimbursement, and processes payment for Medical Evidence of Record and Consultative Examinations for all offices statewide;

Creates and maintains accurate vendor database; Assists with vetting and monitoring of contracts;

Validates authorization and accesses DSHS document management system and determines what confidential information is needed for claim decisions and processes selected information;

Maintains Hearing Officer records and schedules; processes requests for medical records, consultative examinations, and supplemental information submitted by the Administrative Law Judges of Office of Disability Adjudication and Review;

Monitors, prepares, and reports leave, time and attendance documents for a unit, region and/or office;

Performs other duties as required.

Legal Requirement(s)

Background Checks are required by the Social Security Administration.

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.

Desirable Qualifications

Bachelor's degree and at least one year of experience working with disability, medical or health insurance claims adjudication or investigation, or closely related field. 

                                                                             OR

At least one year of professional experience handling claims in a Disability Determination Services office or Social Security Administration. 

                                                                             OR

Additional years of qualifying experience will substitute year for year for education.

Class Specification History

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