Health Management Systems, Inc. Third Party Resource Specialist in Westerville, Ohio

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.

We are seeking a talented individual for a Third Party Resource (TPR) Specialist who is responsible for researching and verifying Third Party Liability insurance and updates the state MMIS system. Responsible for verifiying and updating Third Party Liability eligiility.lity standards are met.

Essential Responsibilities:

  • Researches and verifies eligibility information via online lookups to carrier eligibility websites or by phone with various carriers and updates the state MMIS system.

  • Loads a minimum of 20-25 adds per day into the state MMIS system and terminates existing TPL insurance policies.

  • Answers incoming calls from providers, Medicaid recipients, and other entities in relation to private/commercial insurance.

  • Maintains an accuracy of 99% or above on all work activities per contractual obligation with state.

Non-Essential Responsibilities:

  • Performs other functions as assigned

Knowledge, Skills and Abilities:

  • Ability to be careful and thorough.

  • Ability to build relationships both in person and over the phone.

  • Ability to work proficiently with company software used on the project (i.e. Microsoft Word, Excel, ImageNow, etc.).

  • Ability to navigate various websites.

  • Working knowledge of HIPAA privacy and security rules.

  • Ability to organize well.

  • Ability to perform well in team environment.

  • Ability to work independently to meet objectives.

  • Ability to meet deadlines.

  • Develops effective working relationships with internal and external clients.

  • Adheres to corporate and office policies.

  • Maintains an accuracy of 99% or above on all work activities-per contractual obligation with state.

  • Proactively identify areas of improvements within daily work activities

  • Gain general understanding of HMS and office operations

Work Conditions and Physical Demands:

  • Primarily sedentary work in a general office environment

  • Ability to communicate and exchange information

  • Ability to comprehend and interpret documents and data

  • Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)

  • Requires manual dexterity to use computer, telephone and peripherals

  • May be required to work extended hours for special business needs

  • May be required to travel at least 10% of time based on business needs

Minimum Education:

  • High School Diploma or GED required; Associate’s degree preferred.

Minimum Related Work Experience:

  • 1 years experience in insurance verifications.

  • Customer call center environment experience.

  • Knowledge of state Medicaid systems.

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Title: Third Party Resource Specialist

Location: Ohio-Westerville

Requisition ID: 18001112

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