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