Description
Reports To: Insurance Manager / Insurance Supervisor
Classification: Non-Exempt
Position Description
The MVA/TPL Resolution Specialist II is an experienced specialist responsible for independently investigating, negotiating, and resolving complex hospital accounts involving Motor Vehicle Accident (MVA) and Third-Party Liability (TPL) claims. The Specialist II manages complex, disputed, escalated, high-dollar, and attorney-represented accounts requiring advanced knowledge of liability claims, insurance coverage, hospital liens, healthcare reimbursement, and settlement resolution. The position works directly with insurance carriers, claims adjusters, attorneys, patients, and other involved parties to maximize client recovery while protecting applicable lien and reimbursement rights. The Specialist II also serves as a subject-matter resource to less experienced team members and supports the continued development of MVA/TPL workflows and best practices.
Major Areas of Responsibility
- Independently manage complex MVA/TPL accounts from initial investigation through final resolution.
- Analyze registration, diagnosis, accident, insurance, clinical, billing, payment, legal, and account information to determine appropriate recovery strategy.
- Conduct detailed investigation of accident circumstances, responsible parties, liability status, available coverage, claim numbers, policy-limit concerns, attorney representation, multiple claimants, and other potential sources of reimbursement.
- Identify and pursue appropriate primary, secondary, and alternative sources of recovery.
- Evaluate complex hospital lien circumstances and determine appropriate lien actions within applicable requirements and client guidelines.
- Prepare, submit, document, monitor, and manage hospital liens and related notices.
- Monitor settlement developments, lien deadlines, documentation requirements, coverage issues, and other critical account milestones.
- Communicate and negotiate directly with liability insurance carriers, claims adjusters, personal-injury attorneys, patients, and other parties concerning complex account resolution.
- Evaluate settlement proposals based on account balance, available insurance coverage, liability information, lien position, settlement circumstances, competing claims, and client-approved guidelines.
- Develop and communicate counteroffers and settlement recommendations.
- Negotiate appropriate resolutions within assigned authority and escalate matters requiring client or leadership approval.
- Research and resolve disputed, delayed, underpaid, denied, high-dollar, or otherwise complex MVA/TPL accounts.
- Analyze unusual account circumstances and independently determine appropriate next steps within established policies and client requirements.
- Review payments, contractual or negotiated adjustments, account balances, settlement activity, and account disposition to ensure accurate final resolution.
- Identify accounts presenting financial, compliance, lien, documentation, or recovery risks and escalate when appropriate.
- Maintain detailed documentation supporting investigations, negotiation activity, settlement decisions, lien actions, and account resolution.
- Utilize Electronic Health Records (EHR), payer and carrier resources, client systems, legal documentation, and Revco account-management systems to research and resolve assigned accounts.
- Maintain compliance with HIPAA, applicable regulatory requirements, client requirements, and company policies and procedures.
- Serve as a resource to Level I Specialists regarding complex accounts, MVA/TPL procedures, lien processes, carrier and attorney interactions, and account-resolution strategies.
- Assist leadership with training, workflow development, reference materials, templates, and MVA/TPL best practices.
- Identify trends, recurring recovery barriers, process gaps, and opportunities for improved reimbursement and communicate recommendations to leadership.
- Support escalated accounts, special projects, client initiatives, and additional assignments as requested by management.
Requirements
Qualifications
- 3–5+ years of experience in MVA/TPL, bodily injury claims, subrogation, medical lien resolution, complex healthcare reimbursement, or a closely related liability-claims environment.
- Direct hospital or provider-side revenue cycle experience strongly preferred.
- Demonstrated experience independently investigating accident-related claims and identifying available insurance coverage and other sources of reimbursement.
- Demonstrated experience communicating and negotiating with liability insurance carriers, claims adjusters, attorneys, and other external parties.
- Working knowledge of hospital liens and lien-related reimbursement processes.
- Experience preparing, submitting, monitoring, and resolving hospital liens strongly preferred.
- California MVA/TPL and California hospital lien experience strongly preferred.
- Strong understanding of healthcare billing, account balances, claims, payments, adjustments, denials, and reimbursement processes.
- Demonstrated ability to independently analyze complex accounts and develop appropriate resolution strategies.
- Strong negotiation, critical-thinking, problem-solving, and decision-making skills.
- Ability to evaluate settlement proposals and develop supported recommendations.
- Strong written and verbal communication skills.
- Ability to manage complex, high-priority accounts with varying deadlines and resolution requirements.
- EPIC, Cerner, Meditech, CRXIS, or comparable patient accounting/account-management system experience preferred but not required.
- Healthcare revenue-cycle, claims, insurance, or liability-related certifications are a plus but not required.
Level of Decision-Making The MVA/TPL Resolution Specialist II exercises significant independent judgment within established client and company guidelines. The Specialist independently determines account strategy, handles complex investigations and negotiations, develops settlement recommendations, and resolves accounts within assigned authority. Matters outside delegated authority or involving significant financial, legal, or client risk are escalated to management.
Revco Solutions is an Equal Opportunity Employer committed to providing equal employment opportunities to all qualified applicants and employees. Employment decisions are made without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local law.
Revco Solutions is committed to complying with applicable employment laws and providing reasonable accommodations to qualified individuals with disabilities and applicants with known limitations related to pregnancy, childbirth, or related medical conditions, as required by law. Applicants who require reasonable accommodation during the application or hiring process are encouraged to contact Human Resources.
