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Click here or scroll down to respond to this candidateCandidate's Name
PHONE NUMBER AVAILABLE EMAIL AVAILABLE LINKEDIN LINK AVAILABLE Parsippany NJ, Street Address
Highly efficient claim examiner with experience in insurance industry. Versatile professional offering key competencies within the Claims Examining fields. Accountable for identifying, investigating, evaluating, obtaining and utilizing critical information to accurately adjudicate claims. Demonstrated ability to direct and complete multiple projects while meeting strict deadlines. Knowledge of workers compensation rules and regulations. Skilled and experienced in bill review, and bill coding. Possess strong written and oral communications skills.PROFESSIONAL SKILLSAnesthesia/Pain ManagementBill ReviewClaims/Personal Injury ProtectionMedical Records/InvoicingCase ManagementFinancial/Records ReconciliationAccounts Receivable (AR)Medical Billing/PaymentsRecord MaintenanceFinancial ManagementMicrosoft Office SuiteCoding/Billing CodingOrganizational SkillsRelationship ManagementLeadership SkillsPROFESSIONAL EXPERIENCENational General Insurance Company, Saddle Brook, NJNew York PIP Claim Examiner, 02/2019 PresentProvide problem resolution expertise in matters of errors and reconciliation.Preserve confidentiality of all claim files, claim reports and claim-related issues.Ensure claim files are properly documented and claims coding is correct.Handle Personal Injury Protection claims from inception through closure in compliance with Regulation 68.Review PIP coverage, investigate and analyze injuries to make as to coverage and course of action.Utilize Peer Reviews and Independent Medical Examinations to ensure medical necessity of treatments and procedures rendered.Evaluate claims for potential fraud indicators/work closely with SIU.Review and issue Lost Wages and reimbursement for other necessary medical expenses.Maintain communication with all involved parties (providers, attorneys and employers) in timely and professional manner.Assist with litigations and settlement procedures.Follow proper client and state regulations to ensure compliance with appropriate guidelinesNK PLIGA, Basking Ridge, NJMedical Bill Review & Coding Coordinator, 09/2017 02/2019Updated and recorded confidential information including address changes, billing accounts at customer's request.Utilized coding guidelines, bundling/unbundling codes, contract rates, fee schedules, and UCR to process and pay/deny bills.Delivered significantly lower amount of outstanding bills by implementing specific business initiatives.Protected company/patient from potential fraud and overbilling through investigations and close monitoring of suspicious providers.Emergency Medical Associates, Parsippany, NJWorkers Compensation and PIP Analyst, 07/2012 07/2017Performed day-to-day operations of analyst such as research/address denials and appeals and identify trends and changes in state policies and regulations.Supported Microsoft Dynamics GP including Integrations, implementations, and maintenance of 3rd party productsOversaw PIP and Workers Comp bills for five states.Secured higher tier reimbursement for service rendered out of network by leveraging billing negotiation techniques.Coordinated with adjusters, attorneys, and medical providers to ensure proper reimbursement for services rendered.One Call Medical Finance Department, Parsippany, NJBill Review Specialist, 07/2011 06/2012Executed administrative activities which included managing projects, composing letters, and compiling reports.Prepared weekly/monthly reconciliation reports of cash flow and claims.Analyzed bills for medical provider for entire provider network in USA.Gained and implemented knowledge of different PPO networks, Fee Schedule/UCR states and various regulations.Solved billing issues by utilizing proper coding and assessment of incorrectly paid claims.Urology Specialty Care and Surgicare Associates, P.A, Fair, NJBilling Coding and Collection Specialist, 02/2004 09/2009Maintained all medical claims for doctors office and facility.Managed personnel resolved issues and inconsistencies and utilized appropriate corrective procedures.Administered duties of posting charges, handled cash, and compiled monthly AR reports.Supervised billing team consisting of eight team members.Served as liaison between service providers and insurance companies.EDUCATIONBachelor's Degree in Physical Therapy College of Medicine, Krakow, PolandCertificate in Medical Billing and Coding Berdan Institute, Totowa, NJActive NY PIP Claim Examiner LicenseLANGUAGESEnglish FluentPolish - FluentPersonal Injury Protection Claim AdjusterDriving Success Through Team Leadership, Relationship Development and Continuous Improvement |
