Coding & Reimbursement Specialist

New Jersey Manufacturers Insurance Company 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.

Hours: Monday to Friday from 8AM to 4:15PM

Hybrid opportunity once training is complete

Essential Duties and Responsibilities: Essential functions of this job are listed below in order of priority. Reasonable accommodations may be made to enable individuals to perform the essential duties. Regular and predictable onsite attendance is an essential function of the job.

• 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: Knowledge, skills & abilities, experience, minimum & desired education, certification and/or license requirements.

• High School Diploma or GED

• Knowledge of Excel, Word and Outlook

• Strong communication and writing skills

• Accuracy and attention to detail

• Knowledge of PIP, Workers Compensation, and/or Medicare coding regulations and guidelines

Preferred Qualifications:

• Knowledge of Mitchell DecisionPoint and/or Guidewire Claim Center

• Certified Professional Coder (CPC) designation

• Bachelor’s Degree preferred

Compensation: Salary is commensurate with experience and credentials.

Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses.

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.