Certified Professional Coder​/PIP Adjuster REMOTE

Position

Certified Professional Coder / Bill Review Expert

Remote

FMLA:
Non-Exempt, Full-Time

Schedule:

M-F 8:00 AM - 4:30 PM

• PIP experience with a 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, e.g., NJ/NY PIP adjuster).

• Use various resources to support reviews, such as CPT guidelines, CPT Assistant, Encoder Pro, and 3M Software.
• Review medical bills submitted by insurance companies related to MVA injuries sustained for NJ and/or NY-covered insureds.
• Interpret medical documentation to ensure accuracy of billed services (e.g., CPT, HCPC codes).
• Assign proper CPT and HCPC 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 (e.g., 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 of experience conducting code reviews, specifically NJ/NY PIP fee schedules.
• Must have attention to detail and ability to quickly identify errors in written reports and legal documentation.
• 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, HCPC, and ICD-10.
• Must have an active CPC certification through AAPC.
• Ability to multi-task.
• Ability to meet critical timelines.
• Willingness to testify on a needed basis on behalf of the customer regarding coding outcomes.
• Willingness to travel for testimony as required.
• Computer experience.
• Excel experience beyond beginner level.
• 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.

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.