Job Description

The primary function of the Senior Administrative Claims Specialist is to serve as the resource for medical coding reviews within our Medical Claims Operation. Provide in-depth research on new or unusual procedures and make recommendations as appropriate. Provide support to the Medical Claims and Legal Departments.

RESPONSIBILITIES

• Review medical documentation to verify correct CPT code usage by provider/facility
• Remain current regarding NY Fee Schedule, Medicare, and coding literature
• Research for documentation to support payment reimbursement
• Create letters of explanation and/or affidavits when coding updates have been performed
• Prepare support for Counsel and Litigation Department to use for defending arbitration and trials; attend hearings to testify as necessary
• Serve as a resource within the Department related to billing and coding issues
• Other duties as assigned

QUALIFICATIONS

• Certified Medical Coder (CPC, CCA, CCS) with high degree of competence in this area with 3-5 years of NYFS/Workers Compensation coding experience
• Hospital and Surgical Coding experience preferred but not necessary
• High School Diploma or GED equivalent; College degree preferred
• Knowledge of CPT coding guidelines, medical terminology, anatomy, and physiology
• Knowledge of CMS/Medicare, NCCI, AMA
• NJ PIP and/or Workers Compensation experience preferred but not necessary
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation
• Analytical and problem-solving capability
• Demonstrate effective verbal and written communication skills
• Proficient with the use of Microsoft Office products (Word, Excel, Outlook)
• Strong internet research skills
• Ability to establish and maintain positive and effective work relationships with coworkers, medical providers, and customers
• Ability to participate in a teamwork approach to accomplish tasks

SALARY RANGE

The pay range for this position is $46,000 to $60,000 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity.​

PERKS & BENEFITS

• 4 weeks accrued paid time off + 9 paid national holidays per year
• Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision)
• Annual 401(k) Employer Contribution
• Free onsite gym at our Woodbridge Location
• Resources to promote Professional Development (LinkedIn Learning and licensure assistance)
• Robust health and wellness program and fitness reimbursements
• Various Paid Family leave options including Paid Parental Leave
• Tuition Reimbursement

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 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.

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