MedData has an excellent career opportunity available as a Claims Specialist - Third Party Liability to work in a hospital setting located in Jacksonville, FL. The schedule for this full time role is 4- 10 hour shifts (4 days on, 3 days off) with one day per weekend is required. Shift times vary from starting at 8am to ending at 10pm.
The purpose of this position is to investigate, facilitate and coordinate benefits for accident claims from auto, home or other liability insurance policies.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- 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 AND REQUIREMENTS
- 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
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stand and walk and must occasionally lift and/or move up to 25 pounds.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
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 apply directly to this posting. IND123
MedData is an Equal Opportunity Employer