Bill Review Coordinator/ PIP Adjuster / Workers' Compensation Analyst
Bill Review Specialist / Coding Coordinator
Diverse billing management background with more than 10 years’ experience in bill review, and bill coding supported by extensive knowledge of medical industry, Workers Compensation and of PIPs. Executed a variety of business and financial management skills, high-level negotiations, and strategic planning functions to obtain company objectives. Demonstrated expertise in managing personnel and reducing expenses. Diligently forging strong, long-lasting industry connections with key industry provider and insurance representatives. Utilizing smart business acumen to ensure continuous corporate compliance through trend identification of regulations and legislation.
National General Insurance Company, Saddle Brook, NJ
New York PIP Claim Examiner, February 2019-Present
Handle Personal Injury Protection claims from inception through closure in compliance with Regulation 68.
Review PIP coverage, investigate and analyze injuries to make as to coverage and course of action.
Utilize Peer Reviews and Independent Medical Examinations to ensure medical necessity of treatments and procedures rendered.
Evaluate claims for potential fraud indicators/work closely with SIU.
Review and issue Lost Wages and reimbursement for other necessary medical expenses.
Maintain communication with all involved parties (providers, attorneys and employers) in timely and professional manner.
Assist with litigations and settlement procedures.
NJ PLIGA, Basking Ridge, NJ
Medical Bill Review & Coding Coordinator, September 2017-February 2019
Helm all responsibility for functions such as medical portion of PIP/Workers’ Comp claims, analyzing/evaluate medical claims, and authorize or deny payment of bill. Determine if continued treatment is reasonable. Utilize coding guidelines, bundling/unbundling codes, contract rates, fee schedules, and UCR to process and pay/deny bills.
Delivered significantly lower amount of outstanding bills by implementing specific business initiatives.
Protect company/patient from potential fraud and overbilling through investigations and close monitoring of suspicious providers.
Emergency Medical Associates, Parsippany, NJ
Worker's Comp and PIP Analyst, July 2012-July 2017
Performed day-to-day operations of analyst such as research/address denials and appeals and identify trends and changes in state policies and regulations.
Oversaw PIP and Workers’ Comp bills for five states.
Secured “higher tier reimbursement for service rendered out of network by leveraging billing negotiation techniques.
Coordinated with adjusters, attorneys, and medical providers to ensure proper reimbursement for services rendered.
One Call Medical Finance Department, Parsippany, NJ
Bill Review Specialist, July 2011-June 2012
Executed administrative activities which included managing projects, composing letters, and compiling reports. Prepared weekly/monthly reconciliation reports of cash flow and claims. Monitored and identified industry trends.
Analyzed bills for medical provider for entire provider network in USA.
Gained and implemented knowledge of different PPO networks, Fee Schedule/UCR states and various regulations.
Solved billing issues by utilizing proper coding and assessment of incorrectly paid claims.
New Jersey Institute of Radiology
Urology Specialty Care and Surgicare Associates, P.A, Fair Lawn, NJ
Billing Coding and Collection Specialist, February 2004-September 2009
Maintained all medical claims for doctor’s office and facility. Managed personnel resolved issues and inconsistencies and utilized appropriate corrective procedures. Administered duties of posting charges, handled cash, and compiled monthly AR reports.
Supervised billing team consisting of eight team members.
Served as liaison between service providers and insurance companies.
Areas of Expertise
Claims/Personal Injury Protection/Workers Compensation Coding/Billing Coding Financial/Records Reconciliation
Medical Billing/Payments Therapy/Pain Management Financial Management
Medical Records/Invoicing/ Accounts Receivable (AR)/
Bachelor's Degree in Physical Therapy College of Medicine, Krakow, Poland
Certificate in Medical Billing and Coding Berdan Institute, Totowa, NJ
Active NY PIP Claim Examiner License
English (Fluent) Polish (Fluent)