Medical/Legal Accounts Specialist (A/R)

South Florida Orthopaedics & Sports Medicine PA•Stuart, FL

About The Position

The Medical/Legal Insurance Specialist is a key representative of SFO’s Medical/Legal program, serving patients involved in motor vehicle accidents and slip-and-fall cases . You will monitor the status of legal cases, facilitate timely communication among attorneys , physicians , patients , and carriers , and partner closely with the Medical/Legal Coordinator to optimize each patient’s experience within our practice.

Requirements

Required Experience in medical insurance, personal injury/PIP, or revenue cycle within a healthcare setting.
Demonstrated knowledge of HIPAA and patient privacy practices.
Clear, professional communication skills and ability to manage multiple cases and deadlines with precision.
Proficiency with EHR/PM systems (experience documenting in NextGen strongly preferred).

Nice To Haves

2+ years in medical/legal insurance or personal injury case coordination.
Working knowledge of Florida Auto/PIP regulations and coordination of benefits.
Experience collaborating with attorneys and clinical teams on settlements and claim workflows.

Responsibilities

Answer inbound calls to resolve patient/adjuster questions quickly and accurately within Medical/Legal guidelines and HIPAA requirements.
Communicate professionally with attorneys and their staff, SFO physicians and staff, patients, and other case stakeholders; maintain working knowledge of area attorneys and legal teams.
Manage email correspondence inside and outside the practice; document all case communications in NextGen EMR.
Ensure all required documents are signed (Auto Disclosure, EMC, Payment Agreement); obtain missing signatures promptly.
Educate patients on PIP , coordination of benefits, health insurance (in/out-of-network), and scenarios with no health insurance; set clear expectations for the claim journey.
Monitor case status, settlements, and demand stage; collaborate with physicians on settlement terms and proactively notify AR Manager of expected dates and amounts.
Post payments (e.g., settlement checks, attorney checks for PIP file reviews); reconcile/close batches and provide to the Billing Manager.
Maintain strong knowledge of Florida Auto/PIP statutes and regulations , third-party coverage, coordination of benefits, plan types/levels, and relevant medical/legal developments; serve as a resource to the Medical/Legal Coordinator and SFO staff.
Meet regularly with the AR Manager to review AR status and prepare account/case updates.
Collaborate with A/R, scheduling, and clinical teams to research and resolve motor vehicle accident and attorney-related claims.
Coordinate medical-legal appointment needs, including authorizations, documentation, and payor requirements.
Monitor coordination of benefits to accurately determine patient responsibility, ensure appropriate billing, and serve as a point of contact for patient and attorney inquiries.
Track treatment plans and partner with internal teams to support disclosures, records requests, and anticipated settlement timelines.
Assist with financial counseling referrals and payment plan coordination when applicable.
Perform other duties as assigned