Claims Theory
Job description
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 are assigned
Assign proper codes as needed based on review outcome
Use various resources, e.g., eBooks and 3M software to support reviews
Interpret fee schedule guidelines and apply those guidelines in daily reviews
Document review outcomes for the 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 with 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 and documentation requirements
Thorough knowledge of CPT, HCPCS, ICD‑10
CPC/AAPC certification required
Ability to multi‑task
Ability to meet critical timelines
Computer experience (including MS Office)
Excel experience beyond beginner level
Independent worker
Ability to manage time when working remotely
Must be able to travel to the Hamilton, NJ office as needed
Effective communication with the team
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