Senior Medical Coding Auditor-Team Lead

We are seeking an experienced individual with a CPC (certified professional coder through AAPC) with team lead experience.

Responsibilities:

· Review medical bills submitted by insurance companies related to MVA injuries sustained for NJ and or NY-covered insureds in accordance with the NJ and/or NY PIP regulations

· Interpret medical documentation to ensure accuracy of billed services IE: CPT, HCPCs codes. Review for unbundled services, modifier usage. Perform crosswalk of billed codes to maximize client savings

· Provide support/training to code review team regarding proper coding guidelines, interpretation of medical documentation and proper adjudication processes.

· Complete and/or QA coder reports

· Establish workflows to improve efficiency and consistency among code review team. Document workflows and carrier specific guidelines.

· Manage daily workflows to ensure tasks are completed in accordance with carrier specific TAT.

· Conduct a yearly review of CPT coding changes, educate staff and management on changes,

· Review and respond to appeals, outlining the calculation of bill in dispute, sighting regulatory reference points as required.

· 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/or in-person testimony or trial when needed

· Assist with various special projects and other duties as assigned

Qualifications and Experience:

· 3-5 years’ experience reviewing medical bills utilizing the New Jersey/ New York Fee Schedule guidelines

· CPC (certified professional coder) with AAPC in good standing

· Strong communication skills, must be able to explain the outcome of the review, both written and verbally, must be able to communicate effectively and consistently with team

· Extensive knowledge of coding /documentation requirements

· Thorough knowledge of CPT, HCPCs, ICD-10

· Must have active CPC certification through AAPC

· Ability to meet critical timelines

· Willingness to testify on a needed basis on behalf of customers to coding outcomes

· Willingness to travel for testimony as required in NJ/NY

· Leadership experience

· Ability to manage time when working remotely

· Must be able to travel to Hamilton NJ office on a limited basis