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Martin's Point Health Care Third Party Liability Specialist (Remote) in Portland, Maine

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.

This position offers a remote work schedule with occasional travel to Portland, Maine.

Job Description

  • Process Implementation: Successful execution and ongoing improvement of 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. Continue timely submission of bills, liens and other information to attorneys and insurance companies.

  • Communication: Professional interactions with members, attorneys, and adjusters, ensuring proactive follow-up on case statuses and protections. Ensure clear, timely, and effective communication with all stakeholders.

  • Coordination and Compliance: Alignment 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.

  • Reporting: Development and submission 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

  • Bachelors degree in Business Administration, Healthcare Management, or related field preferred

  • Two to three years claims processing experience within a managed healthcare environment, including two or more years of Coordination of Benefits (COB)

  • One to two 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 other database program)

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

Martin’s Point Health Care is a progressive, not-for-profit organization providing care and coverage to the people of Maine and beyond. The organization operates six primary care health care centers in Maine and New Hampshire, accepting most major insurance plans. Martin’s Point also administers two health plans: Generations Advantage (Medicare Advantage plans available throughout Maine and New Hampshire), and the US Family Health Plan (TRICARE Prime® plan for active-duty and retired military families in northern New England, upstate New York, and western Pennsylvania). For more information, visit https://careers.martinspoint.org .

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