PIP Claims Examiner

About the RoleReview medical bills submitted by insurance companies related to MVA injuries sustained for NJ and or NY-covered insureds.ResponsibilitiesInterpret 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.Qualifications3-5 years experience conducting code reviews; specifically NY and NJ PIP fee schedules.Required SkillsPIP experience with high level understanding of fee schedule guidelines in NYC.CPC in good standing with AAPC required (may consider candidate with strong PIP experience, IE: NJ/NY PIP adjuster).Preferred SkillsMust 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.Have CPC certification through AAPC.Pay range and compensation package $55,000-$65,000Schedule: M-F 8am-4:30pm, fully remote