Claims Theory
Certified Professional Coder Claims Theory•Rochester, NY, US
Certified Professional Coder / Bill Review Expert
Responsibilities:
Review medical bills related to MVA injuries sustained for NJ and or NY covered insureds
Conduct reviews of medical bills and supporting documentation to ensure proper codes assigned
Assign proper codes as needed based on review outcome
Use various resources, IE: eBooks, 3M software to support reviews
Interpret fee schedule guidelines and apply those guidelines in daily reviews
Document review outcomes for customer in a professional easy to understand manner
Participate in conference calls as needed with customer and/or attorneys
Assist with various special projects and other duties as assigned
Qualifications and Experience:
3-5 years of medical billing experience specifically NJ / NY PIP fee schedules
Strong communicate skills, must be able to explain outcome of review, both written and verbally
Extensive knowledge of coding /documentation requirements
Thorough knowledge of CPT, HCPCs, ICD-10
CPC/AAPC certification required
Ability to multi-task
Ability to meet critical timelines
Excel experience beyond beginner
Ability to manage time when working remotely
Must be able to travel to Hamilton NJ office as needed
Ability to effectively communicate with team
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