Specialty Review Analyst

*** Applicants must reside in PA or NJ for consideration***

Job Summary:

This position is responsible for the end-to-end handling of appeals, personal injury protection (PIP) arbitrations, and workers compensation claim payment petitions. The Customer Issue Resolution specialist is a  Dispute Analyst responsible for reviewing all bills cited in the appeals/arbitration/claim petition, verifying payment accuracy and developing the best possible resolution strategy at the lowest possible cost. This includes creating persuasive written arguments based on gathered supporting documentation, negotiating settlements with attorneys, communicating with client adjusters, and providing education to all applicable parties.

Responsibilities:

• Maintain current knowledge of New Jersey Personal Injury Protection (PIP) and workers compensation rules and regulations.
• Act as a liaison between Medrisk and its clients/adjusters.
• Manage litigation calendar and log.
• Review/verify the accuracy of medical bill payments in accordance with State regulations and provider contracts.
• Creates persuasive written arguments based on gathered supporting documentation.
• Negotiate settlements with plaintiff attorneys.
• Educate providers and attorneys on medical bill reimbursement guidelines in accordance with the contract and State regulations.
• Communicate with attorneys, providers and client adjusters.
• Track and trend issues and brings to resolution.
• Perform other duties as requested by Manager.

Education/Experience:

• High School Diploma/GED required.
• Prefers a minimum of three to five years of experience in NJ PIP.
• Experience in appeals/arbitration handling and claim handling preferred.

Knowledge:

• Prefers working knowledge of the New Jersey Personal Injury Protection (PIP) rules and regulations, and PIP arbitrations.
• Requires understanding/knowledge of medical billing, coding and medical bill reimbursement.
• Must be proficient in the use of personal computers and Microsoft Office Products such as Word, Excel and PowerPoint.

Skills and Abilities:

• Must be proficient in the use of personal computers and Microsoft Office Products such as Word, Excel and PowerPoint.
• Requires excellent communication and negotiation skills.
• Requires excellent analytical and critical thinking skills.
• Must have the ability to work independently within the team, with minimal supervision
• Must have the ability to multitask.
• Must be detailed oriented and have strong organizational skills.
• Must be customer service oriented.
• Must be flexible, adaptive and decisive.