TPL Claims Representative

Job ID
2017-2156
Category
Other
US-NV-Reno

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 Representative - Third Party Liability to work in an office setting located in Reno, NV. 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:  

  • 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. Requests 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
  • Secure documentation from medical providers, insurance companies, police departments, and patients, and accurately update pending liability cases with new information obtained from the documents
  • Obtain bills and medical records from medical providers and send them to insurance companies for processing. 
  • Verify information obtained from patients and medical providers regarding insurance coverage with insurance companies for accuracy
  • Assist patients in the filing of first party claims
  • Administer hospital liens for third party liability claims
  • Administer liens in compliance with state lien statute parameters regarding lien format, content, and notification requirements

 

QUALIFICATIONS: 

  • High School Diploma or GED
  • Thorough knowledge of the liability claims adjudication process
  • Ability to communicate effectively verbally and in writing
  • Proven ability to be assertive in order to proactively resolve issues.
  • 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.

 

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. IND123

 

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


MedData is an equal opportunity employer. 

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