Certified Professional Coder, PIP Adjuster
Location
New Jersey + 1 moreAll locations: New Jersey | New York
Posted
108 days ago
Salary
$55K - $70K / year
Seniority
Senior
Job Description
Certified Professional Coder, PIP Adjuster
Medlogix, Llc
• 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
Job Requirements
- 3-5 years experience conducting code reviews; specifically NJ / NY PIP fee schedules
- 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
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Medical Coder III
SAICSAIC® is a premier mission integrator focused on advancing the power of technology and innovation to serve and protect our world. Our robust portfolio of offerings across the defense, space, intelligence, and civilian markets includes secure high-end solutions in mission IT, enterprise IT, engineering services, and professional services. We integrate emerging technology, rapidly and securely, into mission critical operations that modernize and enable critical national imperatives. We are approximately 23,000 strong; driven by mission, united by purpose, and inspired by opportunities. SAIC is an Equal Opportunity Employer. Headquartered in Reston, Virginia, SAIC has annual revenues of approximately $7.3 billion. For more information, visit saic.com . For ongoing news, please visit our newsroom .
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description SAIC is looking for a Full-Time Remote Medical Coder III to provide remote medical coding support to government Medical Treatment Facilities assigned under the Defense Health Agency (DHA) Medical Coding Program Branch. - Experience in multiple coding modalities/specialties, such as: - Inpatient professional - Inpatient facility - Same day surgeries - Observation - Emergency Department - Outpatient specialty/primary care encounters Qualifications - A minimum of five (5) years of medical coding and/or auditing experience in four or more medical, surgical, and ancillary specialties within the past fifteen (15) years. - A minimum of one (1) year of performance in the specialty is required to be qualifying. - Multiple specialties encompass different medical specialties (i.e., Family Practice, Pediatrics, Gastroenterology, OB/GYN, etc.) that utilize ICD, E&M, CPT, and HCPCS codes. - Ancillary specialties (PT/OT, Radiology, Lab, Nutrition, etc.) that usually do NOT use E&M codes do not count as qualifying experience. - Coding, auditing, and training exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying experience. - Coding experience limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor. Requirements - Applicants must have ONE of the following medical coding certifications: RHIT/RHIA/CPC/CCS-P/CEMC/CEMA/CCS/CIC. - Applicants who possess multiple certifications from the list above are preferred. - Medical coding personnel shall maintain the required continuing education hours in order to maintain current and proper national certification (requirements for this position). - Selected applicant must do the following before starting, based on government requirements: - Pass a pre-employment coding test - Provide proof of specific vaccinations - Be subject to a government security investigation and must meet eligibility requirements - Must be a US Citizen.
Coder – Counter Affidavit & Auditing
Dane StreetNational Provider of IME and Medical Peer Review Services
• Perform detailed medical coding audits (ICD-10-CM, CPT, HCPCS) • Conduct utilization reviews to determine medical necessity and documentation compliance • Review and prepare demand packages and audit response materials • Analyze records for payer disputes and recoupments • Prepare written audit findings and defensible reports • Provide expert support for depositions and testimony as needed • Review E/M services under 2021+ guidelines • Interpret CMS, LCD/NCD, and payer-specific policies • Identify risk areas and compliance vulnerabilities
• Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS) • Conduct utilization reviews to assess medical necessity and documentation compliance • Review and prepare demand packages for personal injury and insurance cases • Analyze medical records for payer disputes, recoupments, and appeals • Prepare detailed, defensible written audit reports • Provide expert review, affidavit support, deposition preparation, and testimony when required • Interpret CMS guidelines, LCD/NCD policies, and state-specific Medicaid and commercial payer rules • Review E/M services under 2021+ guidelines • Identify compliance risks and documentation deficiencies
• Conduct comprehensive utilization reviews to determine medical necessity and level of care • Review medical records for documentation completeness and clinical appropriateness • Evaluate inpatient, outpatient, and procedural services for compliance with payer guidelines • Assist with preparation and review of demand packages for legal and insurance cases • Analyze cases involving payer disputes, denials, and recoupments • Prepare detailed, defensible written clinical review reports • Provide affidavit support, deposition preparation, and testimony when required • Interpret CMS guidelines, Medicare policies, and state-specific Medicaid requirements • Identify clinical risk, quality-of-care concerns, and documentation deficiencies
