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.

Key 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.

Additional Responsibilities

• 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

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).

Preferred

• 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.

Key Traits for Success

• Detail-driven & organized: You track every eligibility, document, and settlement date.
• Empathetic & patient-focused: You educate and advocate while keeping cases moving.
• Collaborative: You build trust across AR, clinical, scheduling, and legal stakeholders.
• Accountable: You own outcomes, escalate proactively, and improve processes over time.