Case Review Analyst

Position Overview:

The Case Review Analyst performs reviews of responses, or lack thereof, for PIP demands initiated by a letter of intent to an auto carrier. This process includes an analysis of CPT, HCPCS, and Rev Codes to determine if the code is paid correctly according to Medicare/Workers’ Comp fee schedules. This position requires special attention to detail and excellent organizational skills.

Essential Job Functions:

· Must be able to multitask and possess a high level of accuracy and attention to detail.

· Must be able to work in a fast-paced work environment.

· Organized, self-motivated, with the ability to work remotely and independently.

· Pre-Litigation and Florida Personal Injury Protection claim experience in a high-volume law firm or auto insurance company is a plus.

· Experience in reviewing medical records, reports, medical codes and ledgers, Explanation of Benefits/Reviews, and Insurance Correspondence.

· Working knowledge and understanding of auto claims contracts and auto insurance policies and application of case law and state laws and regulations.

· Ability to review PIP insurance correspondence and claims to identify billing errors, underpayments, denials, and rejections.

· Knowledge of Medicare, Workers’ Compensation Fee Schedules.

· Experience using CMS / First Coast CPT Code / Fee Schedule look-up.

· Understanding of basic medical billing process, including coding and terminology.

· Identify problems and solve them according to protocol.

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Additional Requirements:

· Microsoft Office (Word, Excel, Outlook, Teams)

· Excellent computer functioning and navigating skills

· Organizational skills with special attention to detail

· Excellent written and verbal communication (including email)

· Excellent time management skills

· Ability to work independently

· Meet monthly individual and group goals

Job Type: Full-time

Pay: $21.00 - $23.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Physical Setting:

• Office

Schedule:

• Monday to Friday

Work Location: One location