Claim processor

Location: Atlanta, Georgia
Posted On: 8/4/2017
Job Code: 2980_Claims Healthca
Job Description
This position is responsible for the claims’ resolution portion of clients Third Party Coverage Advocate Solution for Motor Vehicle Accidents (MVA), Workers’ Compensation, and other liability accounts. The Third Party Coverage Advocate Resolution Specialist will be responsible for investigating, billing and collecting on hospital claims from Property & Casualty insurance carriers (ex: Auto Insurance, Work Comp). The CCS will communicate with patients, insurance adjusters and attorneys to resolve claims.

• Initiate outbound calls to patients to complete accident interviews via telephone
• Investigate and confirm any medical coverage related to auto, general liability, and/or worker compensation insurance available to the patient, updating the patient file in the system
• Contact Auto/Work Comp insurance carriers and attorneys via telephone to identify available accident insurance coverage for the patient
• Verify patient’s eligibility for coverage and obtain billing contact information for the insurance adjuster and/or attorney
• Send hospital bill to no-fault, third party and workers’ compensation insurances via fax, mail and e-mail
• Follow up for with insurance carriers and attorneys for expedited resolution and payment on patient’s account
• Request documentation where applicable or payment and account status from insurance adjuster or attorney
• Identify any patient attorney representation and confirm patient representation with the attorney office, recording the attorney information in the patient file in the system
• File Hospital Liens (where applicable) and assist in settlement negotiation between the hospital and patient’s attorney/insurance adjuster
• Maintain proper account documentation in CHC’s Case Management System
• Send correspondence to patient, insurance adjusters and attorneys
• Complete account documentation and return account to the hospital once claim has been resolved

Job Requirements
Education / Training:
• High School Diploma or equivalent
• Bachelors degree preferred
Business Experience:
• Minimum of one year revenue cycle (ex: insurance billing, collections) experience
• Property and Casualty (Auto Insurance, Workers’ Compensation) experience preferred
• Health Insurance Appeals experience preferred
• Subrogation and Coordination of Benefits experience preferred
Category:Non-IT  code:new
Job Requirements

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Contact Details
Shahnawaz Khan