TPL Specialist

TPL Specialist
Norcross, GA, United States
Job ID : R0005771
Job ID : R0005771

City: Norcross

State: GA

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.


  • 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


Required Skills/Knowledge:

  • 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.


Requisition ID: R0005771

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