MVA/Third Party Liability Resolution Specialist I

Description

• Reports To: Insurance Manager / Insurance Supervisor
• Classification: Non-Exempt

Position Description

The MVA/TPL Resolution Specialist I is responsible for the investigation, follow-up, documentation, and resolution of hospital accounts involving Motor Vehicle Accident (MVA) and Third-Party Liability (TPL) claims. Working within established client and departmental procedures, the Specialist reviews potential MVA/TPL accounts, investigates available insurance and liability information, coordinates claim and hospital lien activity, and communicates with insurance carriers, attorneys, patients, and other involved parties to support timely reimbursement. The Specialist manages routine to moderately complex accounts through established workflows and escalates complex, disputed, high-dollar, or unusual accounts as appropriate.

Major Areas of Responsibility

• •Review potential MVA/TPL accounts identified through established client criteria and determine whether accounts meet program and scope requirements.
• •Review registration, diagnosis, accident, insurance, clinical, billing, and account information to validate MVA/TPL status.
• •Investigate accident details, responsible parties, auto or liability insurance carriers, claim numbers, attorney representation, and other potential sources of reimbursement.
• •Conduct outbound communication with patients, insurance carriers, claims adjusters, attorneys, and other involved parties to obtain information needed for account resolution.
• •Confirm appropriate claims have been submitted to identified carriers and perform claim follow-up, resubmission, and supporting documentation activities.
• •Prepare and submit required claim documentation, including itemized statements, medical records, accident information, and other supporting materials.
• •Identify accounts requiring corrected claims, demographic or insurance updates, coding review, or other client-system corrections and route requests through established procedures.
• •Prepare, submit, document, and track hospital liens in accordance with established client procedures and applicable requirements.
• •Monitor lien status, notices, documentation requirements, follow-up dates, and settlement activity.
• •Maintain consistent follow-up with liability carriers, attorneys, patients, and other responsible parties concerning claim status and reimbursement.
• •Resolve routine payment, billing, documentation, or claim-processing issues within established procedures.
• •Identify disputed, delayed, underpaid, complex, or unusual accounts and escalate them to a Level II Specialist or leadership as appropriate.
• •Review payments, adjustments, account balances, demographic changes, and other account updates to ensure accurate account resolution.
• •Maintain complete and accurate documentation of investigation, claim activity, carrier and attorney communications, lien activity, payments, and final account disposition.
• •Utilize Electronic Health Records (EHR), payer and carrier resources, client systems, and Revco account-management systems to research assigned accounts.
• •Maintain compliance with HIPAA, regulatory requirements, client requirements, and company policies and procedures.
• •Prioritize daily workload to ensure timely review and follow-up.
• •Identify recurring account issues or barriers and communicate them to leadership.
• •Participate in training and ongoing development related to MVA/TPL claims, hospital liens, and healthcare reimbursement.
• •Perform other duties and special projects as assigned.

Requirements

Qualifications

• •1–3 years of experience in healthcare revenue cycle, medical billing, insurance follow-up, claims administration, MVA/TPL, workers' compensation, bodily injury claims, subrogation, medical liens, or a related environment preferred.
• •Previous hospital or provider-side revenue cycle experience preferred.
• •Familiarity with insurance claims, healthcare billing, payments, adjustments, and reimbursement processes.
• •MVA/TPL or liability claims experience strongly preferred but may be supplemented by relevant healthcare or insurance claims experience.
• •Ability to research account information, identify missing information, and follow established processes through resolution.
• •Ability to communicate professionally with patients, attorneys, claims adjusters, insurance carriers, clients, and internal departments.
• •Strong written and verbal communication skills.
• •Strong organizational and follow-up skills.
• •Demonstrated attention to detail and accurate account documentation.
• •Ability to manage multiple accounts and competing priorities.
• •EPIC, Cerner, Meditech, CRXIS, or comparable patient accounting/account-management system experience preferred but not required.

Level of Decision-Making The MVA/TPL Resolution Specialist I works primarily within established procedures, guidelines, and resolution parameters. Accounts requiring significant negotiation, interpretation of complex liability issues, unusual lien circumstances, settlement recommendations, or exceptions to established guidelines are escalated to a Level II Specialist or leadership.

Revco Solutions is an Equal Opportunity Employer committed to providing equal employment opportunities to all qualified applicants and employees. Employment decisions are made without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local law.

Revco Solutions is committed to complying with applicable employment laws and providing reasonable accommodations to qualified individuals with disabilities and applicants with known limitations related to pregnancy, childbirth, or related medical conditions, as required by law. Applicants who require reasonable accommodation during the application or hiring process are encouraged to contact Human Resources.