Xerox

Purpose:
•  Responsible for collecting overdue payments and establishing re-payment arrangements.

•  Negotiates liability settlement of medical claims with third parties or healthcare providers; seeks reimbursement from healthcare providers and/or ensures payment of claims by appropriate insurance carrier.


Scope:
General:
•  Builds knowledge of the organization, processes and customers

•  Requires knowledge and experience in own discipline; still acquiring higher level knowledge and skills

•  Receives a moderate level of guidance and direction

•  Moderate decision making authority guided by policies, procedures, and business operations protocol


Primary Responsibilities:
•  May perform one or more of the following duties:

•  Settles the health plan’s subrogation (i.e. third party liability claim) and reimbursement interest; negotiates with the service provider, insurance attorney, insured, etc.  in pursuit of recovering payments for services that should have been paid by another party

•  Applies legal principles and practices of subrogation to maximize recoveries

•  Analyzes and reviews paid medical claims to ensure the recovery amount is consistent with settled agreement

•  Applies coordination of benefits (COB) practices to minimize overpayment by client

•  Perform onsite auditing of healthcare providers’ accounting records to identify and recover overpayments made by client

•  Reviews and interprets employee benefit plan language or insurance contracts to ensure the plan rights are adhered to

•  Ensures compliance with federal, state and local legislation regarding reporting and privacy issues

•  All other duties as assigned