NJM Insurance Group has an opening for a Coding & Reimbursement Specialist in its Medical Claim Services Department. The location for this position will be based in West Trenton. 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.
Job 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).
Required Qualifications and Experience:
- High School Diploma/GED required
- Bachelor’s Degree preferred
- Knowledge of Excel, Word and Outlook
- Strong communication and writing skills
- Accuracy and attention to detail
Preferred Experience:
- Knowledge of PIP, Workers Compensation, and/or Medicare coding regulations and guidelines
- Knowledge of Mitchell DecisionPoint and/or Guidewire Claim Center
- Certified Professional Coder (CPC) designation
Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.