Certified Professional Coder/ PIP Adjuster
Certified Professional Coder / Bill Review Expert
Location
Remote- Anywhere in US
Responsibilities
- Review medical bills submitted by insurance companies related to MVA injuries sustained for NJ and or NY-covered insureds
- Interpret medical documentation ensure accuracy of billed services IE: CPT, HCPCs codes
- Assign proper CPT, HCPCs codes based on the review outcome
- Review CPT codes for unbundled services
- Review billed modifiers for accuracy of use
- Crosswalk CPT codes per regulatory requirements to ensure correct reimbursement
- Interpret fee schedule guidelines and apply those guidelines in daily reviews
- Document review outcomes for customers in a professional easy to understand manner
- Use various resources, IE: eBooks, 3M software to support reviews
- Participate in conference calls as needed with customers and/or attorneys
- Participate in virtual and in-person testimony or trial when needed
- Assist with various special projects and other duties as assigned
Qualifications and Experience:
- 3-5 years experience conducting code reviews; specifically NJ / NY PIP fee schedules
- Strong communication skills, must be able to explain the outcome of the review, both written and verbally
- Extensive knowledge of coding /documentation requirements
- Thorough knowledge of CPT, HCPCs, ICD-10
- Must have active CPC certification through AAPC
- Ability to multi-task
- Ability to meet critical timelines
- Willingness to testify on a needed basis on behalf of customer to coding outcomes
- Willingness to travel for testimony as required
- Computer experience
- Excel experience beyond beginner
- Independent worker
- Ability to manage time when working remotely
- Must be able to travel to Hamilton NJ office as needed
- Ability to effectively communicate with the team