Review accuracy in billing, pre-certification compliance with our Medical Management Departments' decisions, and the re-pricing of the medical bills Review of physician medical records to ensure proper coding was utilized Applicable report generation and distribution Comply with all safety policies, practices and procedures. Report all unsafe activities to supervisor and/or Human Resources. Participate in proactive team efforts to achieve departmental and company goals. Perform other duties as a... more details
Administrative Claims Specialist, PIP
Job LocationsUS-NJ-Woodbridge
ID
2024-5401
Category
Claims
Type
Regular Full-Time
The Administrative Claims Specialist is responsible for supporting the company’s Medical Claims Operation located in Woodbridge, NJ. The candidate should be flexible to perform multiple job functions as requested in a high paced environment.
Essential Functions and Responsibilities
Review accuracy in billing, pre-certification compliance with our Medical Management Departments’ decisions, and the re-pricing of the medical bills
Review of physician medical records to ensure proper coding was utilized
Applicable report generation and distribution
Comply with all safety policies, practices and procedures. Report all unsafe activities to supervisor and/or Human Resources.
Participate in proactive team efforts to achieve departmental and company goals.
Perform other duties as assigned to support the various units within the claims department
Provide support on Provider Service Phone Unit and/or Medical Portal
Ability to use all available applications to answer customer calls, within our guidelines
Manual entry of medical bills in a paperless environment using multiple software applications and dual monitors.
Keying of checks including payroll, interest, etc.
Qualifications and Education
High School Diploma or GED equivalent required; College preferred but not necessary
Ability to establish and maintain positive and effective work relationships with coworkers, providers, and customers
Ability to participate in a teamwork approach to accomplish tasks
Ability to handle multiple tasks simultaneously
Demonstrate effective verbal and written communication skills
Knowledge of Microsoft Office products (Word, Excel, Outlook)
Knowledge of CPT coding guidelines, medical terminology, anatomy and physiology helpful but not necessary
Knowledge of the NJ PIP Fee Schedule, CMS/Medicare, NCCI, AMA helpful but not necessary
About the Company
The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner’s insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,800 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.
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