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

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

Certified Professional Coder, PIP Adjuster

Key skills