Healthcare Subrogation Specialist

1 month ago

Atlanta, Georgia, United States MultiPlan Full time

About MultiPlan: At MultiPlan, we are committed to fostering a vibrant team of forward-thinking professionals. Our mission is straightforward - we aim to transform the financial landscape of healthcare for everyone involved. Our unwavering commitment to excellence in service extends to all stakeholders, motivating us to consistently surpass expectations. We embrace boldness, encourage innovation, promote accountability, celebrate diversity, and empower one another to unlock our collective potential.

Position Overview: Become a vital part of our exciting transformation as we strive to establish ourselves as a premier voice in technology, data, and innovation within the healthcare sector. This position is responsible for managing a digital healthcare subrogation case load through the investigation, pending, and settlement phases of the recovery process. The collaborative work environment emphasizes teamwork; the individual in this role will coordinate efforts with colleagues and legal representatives to achieve efficient and successful resolutions.

Key Responsibilities:

  1. Conduct thorough due diligence, including online research, insurance verification, and court record investigations, to support collections and safeguard lien rights.
  2. Manage all facets of the recovery process in accordance with client-specific protocols, maintaining a calendar diary to track case activities and provide insights to management on trends or developments.
  3. Negotiate settlements for health plan medical claims.
  4. Identify and cultivate subrogation opportunities, ensuring relevant parties are notified.
  5. Respond promptly to all forms of communication, logging information from written and verbal exchanges, and maintaining accurate records as required.
  6. Research and request case details to build cases, accessing and retrieving benefits from clients' remote health claim systems.
  7. Pursue recoveries related to worker's compensation, third-party liability, first-party uninsured and underinsured claims, med-pay coverage, and no-fault recoveries.
  8. Understand fundamental health plan contractual provisions and apply them to reimbursement efforts, ensuring compliance with state and federal regulations.
  9. Maintain departmental productivity and quality benchmarks.
  10. Exercise sensitivity to privacy in accordance with HIPAA guidelines.
  11. Collaborate, coordinate, and communicate effectively across various disciplines and departments.
  12. Ensure adherence to HIPAA regulations and requirements.
  13. Exemplify the Company's Core Competencies and values.
  14. Note: Due to exposure to sensitive data, this role is classified as a High-Risk Role.
  15. The responsibilities outlined above are not exhaustive; additional duties and qualifications may be assigned as necessary.

Job Scope: Prioritize the needs of both external and internal customers when making decisions and taking actions. Operate independently with limited supervision, possessing decision-making authority within specified parameters while seeking the guidance of legal management to proactively resolve cases. Engage with customers, beneficiaries, providers, and supplemental payors while maintaining positive relationships.

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