Coding & Reimbursement Specialist

New Jersey Manufacturers•Trenton, NJ

1d•Hybrid

About The Position

New Jersey Manufacturers Insurance Company has an opening for a Coding & Reimbursement Specialist in its Medical Claim Services Department. The department is seeking an individual that can be a team player while accurately and efficiently auditing medical bills by applying the correct medical, coding, and regulatory guidelines. This is a hybrid opportunity once training is complete. Regular and predictable onsite attendance is an essential function of the job.

Requirements

High School Diploma or GED
Knowledge of Excel, Word and Outlook
Strong communication and writing skills
Accuracy and attention to detail
Knowledge of PIP, Workers Compensation, and/or Medicare coding regulations and guidelines

Nice To Haves

Knowledge of Mitchell DecisionPoint and/or Guidewire Claim Center
Certified Professional Coder (CPC) designation
Bachelor’s Degree

Responsibilities

Accurately and clearly apply regulatory, coding, and medical guidelines, as well as company policies and procedures to audited bills.
Bill negotiation.
Provide concise and clear instructions for bill processing. For those procedures requiring audit reports, cite relevant resources, when appropriate.
Conduct ongoing review and/or audit of bills as needed for appeals, demands for arbitration, and suit. Provide concise and clear audit reports, including rationale for denials and/or reductions, citing relevant resources and supplying supporting documentation, when necessary.
Keep abreast of industry trends and requirements that impact the auditing process.
Research new procedures and technology and provide feedback to team and management on implications.
Recommend value-add strategies for addressing new trends and services.
Report on tasks, audit volume, output, savings, etc., as needed and required by supervisor and/or management.
Complete continuing education credits needed to maintain certification(s).