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Change Healthcare
Louisville, KY, United States (on-site)
20 days ago
Change Healthcare
Louisville, Kentucky, United States (on-site)
20 days ago

Description

Third Party Claims Advocate Resolution Specialist

Change Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities.

Work Location:
Fully Remote - US

Essential Duties and Responsibilities:

*Ability to perform all requirements of Level 1 Resolution Specialist TPC in addition to:

  • 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 Pace and the hospital 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.
  • Maintain proper account documentation in CHC's Case Management System
  • Send correspondence to patient, insurance adjusters and attorneys.
  • Receiving inbound calls from patients, attorneys, insurance companies, etc. and being able to identify the callers need to help come to a resolution (Hunt Group).
  • Working claims 100% of the time.
  • File Hospital Liens (where applicable)
  • Assist in settlement negotiation between the hospital and patient's attorney/insurance adjuster.
  • Aged or high dollar follow up for with insurance carriers and attorneys for expedited resolution and payment on patient's account.
  • Submit appeals for claims that were initially denied or underpayment by auto and workers comp insurance.
  • Adding accounts to the billing list.
  • Responding to attorney requests for itemized bills and statement balances.
  • Complete account documentation and return account to the hospital once claim has been resolved.
  • Posting contractual adjustments in hospital systems.


Performance Measurements/Expectations:

Requirements:

Education

• High School Diploma or GED, Bachelor's Degree Preferred

Experience / Abilities:
  • Minimum of one-year revenue cycle (ex: insurance billing, collections) experience.
  • Meeting or exceeding OKR's
  • Ability to be forward thinking.
  • Demonstrated ability to work with limited supervision.
  • Understanding of Worker's Comp and PIP/Med Pay.
  • Working knowledge of EOB/EOR.
  • Property and Casualty (Auto Insurance, Workers' Compensation) experience preferred.
  • Health Insurance Appeals experience preferred.
  • Subrogation and Coordination of Benefits experience preferred.
  • Strong Communication Skills.
  • Excellent Customer Service Skills.
  • Ability to work collaboratively with a team.
  • Ability to communicate effectively with patients, hospital staff, adjusters and attorneys.
  • General knowledge of commercial health, Medicare, Medicaid, Auto, Work Comp Insurance.
  • Assertive and proactive attitude towards claims resolution.
  • Strong attention to detail.


Unique Benefits*:
• Flexible work environments
Ready, Set, Grow Career Development Center & access to Change Healthcare University for continuous professional learning & development with more than 5,000 training assets
• Volunteer days, employee giving and matching gifts programs, community awards and dollars for doers, community partnerships
• Employee wellbeing programs and generous health plans
• Educational assistance programs
• US 401(k) or Group RRSP (Canada) savings plans with matching employer contributions
• Be sure to ask our Talent Advisors for more information on location specific benefits and paid time off policies
• Learn more at https://careers.changehealthcare.com
*Eligibility for some benefits may be limited or not available for part-time employees, be sure to speak with your Talent Advisor.

Diversity and Inclusion:

•At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.
•Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at https://careers.changehealthcare.com/diversity

Feeling Inspired? Ready to #MakeAChange? Apply today!

COVID Vaccination Requirements

We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and, when j ob-related and consistent with business necessity , we may require periodic testing for certain roles. Some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf .

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.comwith "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare's Privacy Notice to California Job Applicants Regarding the Collection of Personal Information .

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Job Information

  • Job ID: 65710694
  • Workplace Type: On-Site
  • Location:
    Louisville, Kentucky, United States
  • Company Name For Job: Change Healthcare
  • Position Title: Third Party Claims Advocate Resolution Specialist
  • Job Function: Other Profession
  • Job Type: Full-Time
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