TPL Claims Specialist

Job ID
2017-2128
Category
Third Party Liability
US-TX-The Woodlands

About The Company

MedData, a MEDNAX (NYSE: MD) company, is a technology-enabled services organization that improves financial outcomes for hospitals by enhancing the patient experience and expanding their access to healthcare. The MedData managed services program includes a range of patient access and communications, revenue cycle management, and consulting and analytics solutions for healthcare systems, including billing, coding, patient balances, eligibility and enrollment, third party liability, and mobile apps.
 
At MedData, we take great pride in our company, in each other, and in our 30+ year history of accomplishments and success. This pride is reflected in our everyday approach to working together. Each team member understands the importance of being part of a company that values their individual contributions and strives to help them achieve their personal goals as they work together to achieve the broader corporate goals. We believe that every team member contributes directly to MedData’s growth and success, and we are constantly searching for new talented, passionate and enthusiastic people who will take pride in being an integral part of our culture.

Job Description

MedData has an excellent career opportunity available as a Claims Specialist - Third Party Liability to work in an office setting located in The Woodlands, TX. The schedule for this full time role is Monday - Friday 8am-5pm.  

 

POSITION OVERVIEW:

The purpose of this position is to investigate, facilitate and coordinate benefits for accident claims from auto, home or other liability insurance policies.

 

ESSENTIAL JOB FUNCTIONS:  

  • Receive inbound and placing outbound calls 90% of working day
  • Resolve accounts as quickly and accurately as possible, obtaining maximum reimbursement
  • Review and research accident claims to investigate possible leads
  • Bill no-fault and third-party liability carriers when appropriate
  • Request documentation from insurance representatives when no no-fault insurance exists
  • Review and research insurance claims to determine possible payment sources. 
  • Contact various sources including insurance professionals, patients, and other parties to verify relevant data 
  • Coordinate with payors to ensure appropriate filing guidelines are met for reimbursement
  • Request appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition
  • Maintain and update payors on denied claims
  • Ensure that appropriate billing guidelines and standards are met based on payor and/or state
  • Make written or verbal appeals to payers on denied claims
  • Obtain claim status and gathering supporting documentation to submit appeals
  • Evaluate liability cases according to a multitude of factors, including accident type, patient involvement, patient degree of fault, and available insurance coverage. 
  • Make accurate determination of the correct course of action to resolve liability cases based on the above data. 
  • Pursue first party payers for reimbursement of hospital claims
  • Assess state No-Fault laws to determine the availability and extent of first party coverage, and inform uncooperative patients about the proper coordination of available insurance benefits
  • Appeal underpayments made for any reason other than exhaustion of benefits
  • Resolve bodily injury liability claims by asserting and enforcing liens against the liable insurance company
  •  Ensure timely and equitable disbursement of settlement funds

QUALIFICATIONS: 

  • High School Diploma or GED
  • 1-2 years working knowledge of computer functions including the internet and computer software such as Microsoft Office Suite and the ability to learn in-house computer applications.
  • 1-3 years of related experience in the field or in a related area  
  • Ability to communicate effectively verbally and in writing
  • Thorough knowledge of the third party claims adjudication process
  • Thorough knowledge of state lien statutes, CMS secondary payer rules, and state No-Fault laws

 

 

This job description is to serve as a guide but no way is it to be considered a comprehensive list of task, duties and responsibilities that will be required by the employee.

 

 

To join our team of 2,000 employees and growing, please visit apply directly to this posting.


MedData is an equal opportunity employer.

 

Woodlands, Spring, Magnolia, Conroe, TPL, Third Party Liability, Call center, customer service 

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