Discovery Health Partners offers payment and revenue integrity solutions that help health payers improve revenue, avoid costs, and enhance the member experience. We offer a unique combination of deep healthcare expertise and analytics-powered technology solutions to help our clients improve operational efficiency, achieve financial integrity, and generate measurable results.
POSITION DESCRIPTION:
The Paralegal is accountable for managing the coordination of claim payments among health plans and other responsible parties through negotiations for a successful recovery of 1st and 3rd party funds. The candidate must be confident on the phone and comfortable interacting and negotiating with attorneys and other interested parties. Responsibilities include managing a “paperless” healthcare subrogation case load through investigation, pending and settlement stages of the recovery process. The Discovery Health Partners work environment is team oriented; the Paralegal is expected to coordinate efforts with all parties to bring matters to efficient and successful outcome. The employee must be extremely detail oriented and effective in managing the subrogation recovery process.
Candidates should have an interest in the health insurance/personal injury fields and be familiar with managing a mixed case load including workers compensation, third party liability, medical payment, personal injury protection, under insured motorist/uninsured motorist and no-fault coverages. The position includes a training program that teaches the employee about the healthcare subrogation process. Prior subrogation experience is preferred. Previous health insurance experience and negotiation experience is required.
KEY RESPONSIBILITIES & JOB FUNCTION:
- Identify and develop subrogation recovery/settlement opportunities following client specific policies, procedures and guidelines and negotiate settlements in the best interest of those clients and Discovery Health Partners.
- Continuously research and request case information or status to drive cases to resolution.
- Maintain detailed and accurate case records and calendar diaries to monitor case activities to meet department expectations.
- Respond timely to all electronic, written and verbal communications within a defined deadline
- Engage advice and/or help of legal team to proactively resolve cases
- Ensure compliance of all state and federal laws
- Maintain department recovery, productivity and quality standards
- Provide feedback to management on trends or developments
- Calling adjusters and attorneys for status
- Reviewing plan documents for possible exclusions
- Will be responsible for consistency and accuracy on time-sensitive documents.
- Managing a large case load
- Using MS Word, Excel, Microsoft Outlook and other programs in preparation of correspondence and/or other documents
- Comply with HIPAA regulations as well as Discovery’s HIPAA and Information Security policies and procedures, including required training and incident reporting.
Required Skills
- Proven negotiation experience, specifically in the capacity of persuading and influencing others; ability to negotiate fair
- settlements consistence with the prevailing subrogation law
- Effective and exceptional communication skills
- Strong organizational and time management skills with the ability to multi-task and work independently
- Strong analytical problem solving and decision-making skills; ability to exercise good judgment
PREFERRED SKILLS:
- Understand basic health plan contractual provisions and apply to reimbursement efforts
- Paralegal Certificate (Preferred)
Required Experience
- Associate degree, preferably legal studies or paralegal studies1+ years of experience in health, disability or P&C insurance
- Working knowledge of Microsoft Office and internet research skills
- Strong decision making abilities to determine recovery potential and proper reimbursement.
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
- Must have ability to define problems, collect data, establish facts, and draw valid conclusions.
Discovery Health Partners provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.