Role description
Certified Professional Coder/ PIP Adjuster REMOTE
MEDLOGIX, LLCCertified 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.