This is a temporary full-time position.
Starting as soon as possible.
Ending March 2021 (could be extended)
Majority of this will be remote
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 Job Functions
Review and maintain accurate and updated patient information in billing system
Conducts direct contact with patients health insurance company to verify eligibility
Conducts direct contact with patients 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 Billing and A/R challenges or concerns to the Billing and 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
High school diploma or GED
Proven ability to analyze complex process errors and identify root cause corrections.
Healthcare and insurance payer knowledge/experience is preferred.
Professional coding certifications strongly preferred.
Must be able to adhere to confidentiality standards and professional boundaries at all times
Attention to detail
Ability to remain calm and professional in stressful situations
Strong commitment to excellence
Quick-thinking and astute decision making skills
Effective problem-solving and conflict resolution
Excellent organization and communication skills
Must be able to speak, write, read and understand English
Occasional lifting, carrying, pushing and pulling of 25 pounds
Prolonged walking, sitting, standing, bending, kneeling, reaching, twisting
Must be able to sit and climb stairs
Must have visual and hearing acuity
Must have strong sense of smell and touch
Performs duties in an office environment during agency operating hours
Must be able to function in a wide variety of environments which may involve exposure to allergens and other various conditions
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Headhunters and recruitment agencies may not submit resumes/CVs through this website or directly to managers. Aveanna does not accept unsolicited headhunter and agency resumes, and will not pay fees to any third-party agency or company that does not have a signed agreement with Aveanna.
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