Norcross, GA, United States
Job ID : R0005771
Job ID : R0005771
Zip Code: 30092
The primary responsibility of the TPL Specialist is to assist with quality assurance and accuracy of claims review and support of the third party liability (TPL) processes.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Review and maintain accurate and updated patient information in billing system
- Conducts direct contact with patient’s health insurance company to verify eligibility
- Conducts direct contact with patient’s health insurance company to verify services are covered under patients benefit plan
- Initiates authorization process with the health insurance plan
- Communicates required documentation needed to complete the authorization process
- Timely and consistent follow up with locations for requested information
- Confirms any secondary policies and applies same process regarding eligibility, benefits and authorization requirements
- Forecasts and communicates potential A/R challenges or concerns to the A/R managers
- Conducts an accurate review of received documents to determine specific requirements are met for compliance
- Calculates benefits based on each individual policy or plan with strong attention to detail and accuracy
- Attention to detailed information related to Home and Local plans as well as HMO and PPO policies
- Other duties as assigned
REQUIREMENTS / EDUCATION / EXPERIENCE
- Healthcare and insurance payor knowledge/experience is preferred.
- Professional coding certifications strongly preferred.
- Proven ability to analyse complex process errors and identify root cause corrections.
- Strong attention to detail, accuracy, and organization skills.
- Proven ability to meet tight deadlines under pressure.
- Must have excellent communication skills.