Third Party Liability Insurance Follow Up Rep

The Third Party Liability Insurance FollowUp Representative will process claim files for payment from Health plans and/or Third Party Payors: Workmen’s Compensation, Automobile, Property and Casualty, and Health Insurers. Contacts Health plans and/or Third-Party Payors. Attorneys to maximize client reimbursements for services and recover all monies properly owed to our clients. 

In this role you will: 

• Identify viable payer(s) and obtain all necessary documentation to properly process the claim for payment including, when applicable, IBs, UBs, Medical Records, POs, EOBs when necessary. 
• Coordinate benefits with all available payers to appropriately maximize the client’s recovery while minimizing the patient’s personal responsibility. 
• Review and process for payment all claims, in which adequate billing information has been obtained, to the appropriate insurance carrier within 24 hours of receipt of said information. 
• Correspond with patients, employers, policyholders, insurers, police, witnesses or other parties involved in the accident, and attorneys to obtain additional, relevant information to support the claim for monies owed. 
• Review status of litigated claims (if applicable) and confer with attorneys and Third Party carriers regarding case disposition. 
• Converse with the insurer(s) and appeal when appropriate to guarantee that all available benefits are recovered and that claims are reimbursed at the appropriate/maximum level(s). 
• Use the operating systems (FACS, SSI or successor systems, etc.) to perform timely processing and Follow Up on every claim from initial placement thru resolution. 
• Professionally respond to customer inquiries and requests that may require extracting, synthesizing, and analyzing system data. 
• Prepare appeals, account summaries, offers of compromise, pro ration of funds, and compile other relevant data. 
• Remain current with all local, state and federal statutes and act within the limits of the law. 
• Understand all specific billing requirements for each applicable state and payer for which you are responsible. 
• Establish and maintain constructive working relationships with insurance carriers, clients, external business contacts and staff. 
• All Claims Representatives must maintain the highest level of confidentiality and comply with all HIPAA regulations and Business Associate Agreements with its clients. 
• Practices and adheres to the “Code of Conduct” philosophy and “Mission and Values Statement” 
• Attend Privacy and Security Training as required by the HIPAA Awareness Program and comply with all guidelines, policies and procedures to assure sensitive or confidential information is protected in accordance with the HIPAA rules and regulations. 

Qualifications that you will need: 

•  High School Diploma or GED required 
• 2 years of directly related industry experience 
• Relevant education may substitute experience requirement. 
• Must have experience in reading and understanding UB04 and HCFA forms. 
• Experience in Workman’s Compensation and Motor Vehicle Claims processing 

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.