Registered Nurse with 14 years clinical experience and 26 years experience with all aspects of claims management, working as a consultant for auto and worker's compensation insurance companies.
Registered Nurse, licensed in NJ and PA
Certified Professional Coder, CPC
Certified Disability Management Specialist, CDMS
Reviewed auto claims, specifically, provider's billing and supporting documentation to determine if billed codes accurately represented the treatment performed and if the treatment was related to the accident or injury.
Communicated with the claims adjusters if any concerns were noted and notified the provider's of code review outcome, if changes were necessary.
All reviews were performed in compliance with the AMA CPT and HCPCS coding manuals and ICD-9 manual along with NCCI.
Worked with injured workers in getting appropriate medical care arranged and followed up with the providers rendering the care to determine status and need for continued care and return to work.
Responsible for all aspects of provider's bills being input into CSG's system by data entry personnel.
Responsible for providing organization with up to date information on NJ and PA auto and worker's compensation laws and developing a library of all states auto and worker's compensation laws.
Keeping the organization's resource library current with the latest CPT, HCPCS and ICD-9 coding manuals along with other critical resource information.
Worked with New Jersey Department of Banking and Insurance on the development of the rules and regulations surrounding the auto insurance laws.
Liaison to our clients for information to and from the NJ Dept of Banking and Insurance.
Assisted in developing metrics for the organization's patented computer system to comply w/all laws for all lines of business
Consultant for auto and workers compensation insurances specifically:
Auditor of provider and hospital bills on their site or off site
On site review of claims at the insurance companies
Certified Professional Coder
Certified Disability Management Specialist
Companies Worked For:
Job Titles Held: