Third-Party Liability Claims, Manager

Prime Healthcare; Town of Texas (WI); On-site; USD 70,000 - 100,000; Full time

Job summary

Prime Healthcare, an award-winning health system headquartered in Ontario, California, is seeking a Third-Party Liability Claims Manager for its Dallas, TX team. This role focuses on reviewing, analyzing, and resolving hospital claim denials related to Workers’ Compensation and motor vehicle accidents.

The ideal candidate will bring knowledge of payer guidelines, medical billing, and appeals processes to secure appropriate reimbursement for services rendered.

Qualifications

• Experience reviewing denied hospital claims.
• Knowledge of Workers’ Compensation and MVA claim billing and denial processes.
• Experience in hospital revenue cycle or denial resolution.
• Ability to interpret payer guidelines and appeal requirements.

Responsibilities

• Review denied hospital claims for Workers’ Compensation and MVA to determine root causes and resolution strategies.
• Prepare and submit appeals, reconsiderations, and supporting documentation to insurance carriers, TPAs, and attorneys.
• Collaborate with hospital billing, coding, and clinical teams to ensure accurate claim submission and payer compliance.
• Maintain detailed claim activity notes and track status through resolution.
• Research Texas Workers’ Compensation rules to strengthen appeals and ensure compliance.
• Negotiate with payers and adjusters to secure payment or overturn denials.
• Identify trends in denials and recommend process improvements to reduce future rejections.
• Monitor accounts receivable for aging claims and prioritize high-dollar or high-impact cases.
• Communicate effectively with patients, providers, and internal stakeholders regarding claim status and resolution.

Skills

Claims analysis

Denial resolution

Payer negotiation

Regulatory compliance

Education

Associate degree

Bachelor's degree

Job description

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation’s leading health systems with nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Position Summary

We are seeking a skilled Third-Party Liability Claims Manager with expertise in Workers’ Compensation and Motor Vehicle Accident (MVA) claims to join our team in Dallas, TX. This role is responsible for reviewing, analyzing, and resolving hospital claim denials related to workplace injuries and motor vehicle accidents. The ideal candidate will have strong knowledge of payer guidelines, medical billing, and appeals processes, with the ability to secure appropriate reimbursement for services rendered.

Key Responsibilities

• Review and analyze denied hospital claims for Workers’ Compensation and MVA cases to determine root causes and resolution strategies.
• Prepare and submit appeals, reconsiderations, and supporting documentation to insurance carriers, third-party administrators, and attorneys.
• Collaborate with hospital billing, coding, and clinical teams to ensure accurate claim submission and compliance with payer requirements.
• Maintain detailed claim activity notes and track status through resolution.
• Research and interpret state and federal regulations, including Texas Workers’ Compensation rules, to strengthen appeals and ensure compliance.
• Work with payers and adjusters to negotiate payment or overturn denials.
• Identify trends in denials and recommend process improvements to reduce future rejections.
• Monitor accounts receivable (A/R) for aging claims and prioritize high-dollar or high-impact cases.
• Communicate effectively with patients, providers, and internal stakeholders regarding claim status and resolution.

Qualifications

• Associate’s or Bachelor’s degree in Healthcare Administration, Business, or related field (preferred) or equivalent experience.
• 2–4 years of experience in hospital revenue cycle, claims management, or denial resolution.
• Strong knowledge of Workers’ Compensation and MVA claim billing and denial processes