Medlogix, Llc

Title: Certified Professional Coder/ PIP Adjuster REMOTE Location: Hamilton, NJ, US Job Description: Salary Range:$55,000.00 To $60,000.00 Annually 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.

Title: Medical Review Specialist- REMOTE (EST/ CST zone) Location:REMOTE (EST/ CST zone) Job Description: Salary Range:$48,000.00 To $55,000.00 Annually 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. ReviewWorks, a Medlogix company founded in 1989 located in Northville, Michigan. Provides comprehensive Medical Review Services, Medical Case Management Services and Vocational Rehabilitation Services to customers that include self-insured entities, third party administrators and insurance carriers. TITLE: Medical Review Specialist TYPE: Full time – (40 hours per week) Non-Exempt Remote- EST and CST time zone POSITION SUMMARY: The incumbent reviews medical bills utilizing professional knowledge and clinical experience to determine relationship of services billed to the covered injury; applies appropriate review guidelines, assesses appropriate use of medical coding; identifies over-utilization of treatment and makes appropriate reimbursement recommendations. The incumbent is also responsible for the quality timeliness and customer service for assigned accounts. ESSENTIAL FUNCTIONS: - Reviews medical bills and documentation according to guidelines and RW policies and procedures. - Determines if treatment is related and necessary to the covered injury. - Advises reimbursement recommendations are appropriate. - Provides customer service to adjusters, providers, and claimants regarding bill review. - Assesses appropriateness and duration of care provided, for possible utilization review. - Recommends independent medical evaluations (IME) to adjusters when necessary. - Act as a resource to other staff members to facilitate completion of a quality product. - Use appropriate reference material as necessary to perform professional review. - Meets company productivity standards. - Meets company quality standards. Professional Background: Certified Professional Coder – a plus but not required StrataCare software- a plus, but not required 1+ years medical coding experience – CPT, ICD-10 - preferred 1+ years’ experience in Medical Bill Repricing – preferred SKILLS AND ABILITIES: Ability to apply clinical knowledge and/or coding expertise in bill review Ability to read, write, speak, and understand English well Ability to understand and follow written and oral instructions Possess strong verbal and interpersonal skills Ability to multi-task Possess problems solving skills Ability to sit for long periods at a computer terminal keyboarding PC skills – required Knowledge of Microsoft Office Products – required Ability to operate standard office equipment including telephone PERSONAL CHARACTERISTICS: Initiative, drive, creativity and persistence Good organizational skills Highest professional ethics Ability to work independently 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.

Title: Certified Professional Coder/ PIP Adjuster REMOTE Location: Hamilton, NJ, US Job Description: Salary Range:$55,000.00 To $60,000.00 Annually 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.

• Responsible for reviewing and processing insurance claims by verifying policy coverage • Gathering necessary information, evaluating claim validity, and determining the appropriate payout amount • Interact with policyholders, agents, and other stakeholders to facilitate the claims process efficiently • Ensure compliance with HIPPA regulations, including confidentiality • Ability to work in multiple claim systems and provide support to multiple departments, including litigation and legal departments

• Coordinate care with health care providers and insurance carriers • Visit individuals injured in automobile and on-the-job accidents • Maintain detailed records and documentation • Collaborate with clients to ensure effective care management

• Responsible for the overall development and maintenance of the ancillary and facility PPO network contracts • Contracting and rate negotiation functions • Requires strong negotiation skills • Understanding of healthcare contracting and compliance • Foster and manage relationships to improve network efficiency and access for clients • Establish targets for recruitment • Rate negotiations • Contract language negotiations • Establishing and maintaining relationships • Provider education • In-person visits and follow-up • Develop strategy for network expansion and maintenance • Identify network needs in both new and existing service areas • Investigate options, targets, and recruits • Act as liaison between ancillary/facility and appeal department • Negotiate rates and contract language for execution • Assist with credentialing and recredentialing process • Renegotiate/renew existing contracts • Assist with development of Request for Proposals and contract updates • Support Client Services and Sales teams

Title: Medical Review Specialist- REMOTE (EST/ CST zone) Location: Southfield, MI, US Job Description: Salary Range:$48,000.00 To $56,000.00 Annually 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. Type: Full time – (40 hours per week) Non-Exempt Remote- EST and CST time zone Company Summary: ReviewWorks founded in 1989 located in Northville, Michigan. Provides comprehensive Medical Review Services, Medical Case Management Services and Vocational Rehabilitation Services to customers that include self-insured entities, third party administrators and insurance carriers. Position Summary: The incumbent reviews medical bills utilizing professional knowledge and clinical experience to determine relationship of services billed to the covered injury; applies appropriate review guidelines, assesses appropriate use of medical coding; identifies over-utilization of treatment and makes appropriate reimbursement recommendations. The incumbent is also responsible for the quality timeliness and customer service for assigned accounts. Incumbent will be responsible for reviewing bills for Michigan Workers' Compensation claims. ESSENTIAL FUNCTIONS: - Reviews medical bills and documentation according to guidelines and RW policies and procedures. - Determines if treatment is related and necessary to the covered injury. - Advises reimbursement recommendations are appropriate. - Provides customer service to adjusters, providers, and claimants regarding bill review. - Assesses appropriateness and duration of care provided, for possible utilization review. - Recommends independent medical evaluations (IME) to adjusters when necessary. - Act as a resource to other staff members to facilitate completion of a quality product. - Uses appropriate reference material as necessary to perform professional review. - Meets company productivity standards. - Meets company quality standards. Professional Background: 1+ years E&M Experience required Certified Professional Coder – a plus but not required 1+ years medical coding experience – CPT, ICD-10 - preferred 1+ years’ experience in Medical Bill Repricing – preferred Michigan Workers' Compensation experience- preferred SKILLS AND ABILITIES: Ability to apply clinical knowledge and/or coding expertise in bill review Ability to read, write, speak, and understand English well Ability to understand and follow written and oral instructions Possess strong verbal and interpersonal skills Ability to multi-task Possess problems solving skills Ability to sit for long periods at a computer terminal keyboarding PC skills – required Knowledge of Microsoft Office Products – required Ability to operate standard office equipment including telephone PERSONAL CHARACTERISTICS: Initiative, drive, creativity and persistence Good organizational skills Highest professional ethics Ability to work independently 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.

Title: Bill Review Repricer - Level II (Remote) Location: Remote, Remote, US Salary Range:$18.00 To $21.00 Hourly Job Description: 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. Position: Bill Repricer Level II Location: Remote FMLA: Non-Exempt, Full-Time Schedule: M-F 8am-4:30pm General Description: Process Auto Medical and Workers Compensation Bills through various work queues based on jurisdictional and process requirements of Medlogix clients. Responsibilities: - Process and reprice auto medical claims through different system queues in “first in first out” order and making sure to keep up with client and regulatory SLAs. - Resolve bill exceptions, verify bill data (bill images against captured data) and resolve discrepancies, follow and apply claims adjuster instructions, review for medical records and flag errors to rejection queue. - Maintain communication when needed, between yourself and your supervisor - Reach a daily average quota with the amount of claims/jobs you process - Other job duties as assigned Qualifications and Experience: Required: - Excellent written and verbal communication skills - Must be process and task oriented - Computer savvy and previous experience using Microsoft Office Products - 1+ years medical coding experience – CPT, ICD - 1+ years experience in Medical Bill Repricing Preferred: - Previous experience in Auto Claim Management - Previous experience working in a fast-paced production environment 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.

Title: Bill Repricer - Level I (Remote) Location: Remote, Remote, US Salary Range:$15.00 To $19.00 Hourly Job Description: 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. Position: Bill Repricer Level II Location: Remote FMLA: Non-Exempt, Full-Time Schedule: M-F 8am-4:30pm Job duties: - - Process and reprice auto medical claims through different system queues in “first in first out” order and making sure to keep up with client and regulatory SLAs - Maintain communication when needed, between yourself and your supervisor - Reach a daily average quota with the amount of claims/jobs you process - Manually key medical bills from a HCFA, UB, NF-3 or Non-standard billing form - Correct, verify and insert new provider information from bills that are in the processing phase - Associate and claim match medical bills and additional documents from providers to their correct claim files located in MyMedlogix. These documents may come in large packets/files from providers that could contain multiple patients and documents and will need to be split up manually - Other job duties as assigned Qualification: - Excellent written and verbal communication skills - Must be process and task oriented - Computer savvy and previous experience using Microsoft Office Products Preferred: 1+ years medical coding experience - CPT, ICD 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.

• Reviews medical bills and documentation according to guidelines and RW policies and procedures. • Determines if treatment is related and necessary to the covered injury. • Advises reimbursement recommendations are appropriate. • Provides customer service to adjusters, providers, and claimants regarding bill review. • Assesses appropriateness and duration of care provided, for possible utilization review. • Recommends independent medical evaluations (IME) to adjusters when necessary. • Act as a resource to other staff members to facilitate completion of a quality product. • Use appropriate reference material as necessary to perform professional review. • Meets company productivity standards. • Meets company quality standards.