Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Position Summary
The Third-Party Liability Specialist is a crucial member of our team, focusing on managing and facilitating Martin’s Point’s third-party liability operations process in accordance with established policies and procedures. This role involves comprehensive handling of processes such as research, investigation, collection, documentation, and both internal and external reporting to ensure compliance and efficiency in third party liability matters.
Job Description
Key Outcomes:
- Executes and ongoingly improves the third-party liability process. This includes an in-depth understanding of relevant laws and regulations, policy and procedure reviews, case research, database management, and effective lien negotiation strategies.
- Submits bills, liens and other information to attorneys and insurance companies in a timely manner.
- Interacts with members, attorneys, and adjusters, ensuring proactive follow-up on case statuses and protections. Ensure clear, timely, and effective communication with all stakeholders.
- Aligns with MPHC Legal team negotiated outcomes or dispute resolutions.
- Foster strong relations with the Judge Advocate General (JAG) offices and TriCare Management Activity (TMA) to meet the third-party liability requirements stipulated by the Department of Defense contracts.
- Develops and submits of detailed annual reports to the Uniformed Services Claims Office (USCO), adhering to the contractual timelines and requirements for compliance.
Education/Experience
- High School diploma or equivalent required
- Bachelor’s degree in business administration, Healthcare Management, or related field preferred
- 2+ years of claims processing experience within a managed healthcare environment, including Coordination of Benefits (COB)
- 1+ years of claims adjustment/research experience
- Prior experience in a legal environment is preferred
Skills/Knowledge/Competencies (Behaviors):
- Knowledge of all phases of claims adjudication process
- Knowledge of ICD 9 & ICD 10, CPT-4 coding, medical terminology, and third-party insurer billing
- System analysis and/or manual claims pricing skills
- Excellent judgment, initiative, and problem-solving abilities
- Exceptional ability to analyze data
- Excellent multitasking skills
- Excellent time management skills
- Ability to establish and monitor claims data trends to proactively identify opportunities for improvement
- Capable of determining when issues need escalation of prioritization and have reliable follow through
- Working knowledge of Excel, Microsoft Word, and Access (or use of another database program)
There are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin’s Point Health Care? Contact us at:jobinquiries@martinspoint.org
