Certified Professional Coder/ PIP Adjuster REMOTE

MEDLOGIX, LLC
Trenton, NJ, United States

Job Description

Certified Professional Coder/ PIP Adjuster

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.

About this role:

Exciting opportunity with the possibility for growth!

This division of Medlogix is positioned for significant growth in the near future. We are actively hiring to expand the team and as the department grows, there may be opportunities for future advancement into leadership roles individuals who demonstrate mastery of the production role, along with a strong understanding of coding, PIP, and state regulations.

Position: Certified Professional Coder / Bill Review Expert

Location: Remote

FMLA: Non-Exempt, Full-Time

Schedule: M-F 8am-4:30pm

MUST HAVE:

PIP experience with high level understanding of fee schedule guidelines in NY, NJ, FL or MI required
CPC in good standing with AAPC required (may consider candidate with strong PIP experience, IE: NJ/NY PIP adjuster)

Responsibilities:

Use various resources to support reviews; IE: CPT guidelines, CPT Assistant, Encoder Pro, 3M Software
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
Must have attention to details, ability to quickly identify errors in written reports, legal documentation
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

EEOC STATEMENT:

Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.