Personal Injury Claims Specialist

16 hours ago

Winter Park, Florida, United States Sterling Medical Group Full time
Job Description

Sterling Medical Group is a dynamic and rapidly growing healthcare organization committed to delivering exceptional services. With a focus on innovation and excellence, we are seeking a highly skilled and experienced Billing Manager to join our dedicated team.

Position Overview:
We are looking for a seasoned Personal Injury Protection (PIP) Billing Supervisor/Manager with a minimum of 20 years of experience in managing billing operations. The ideal candidate will possess in-depth knowledge of auto insurance and/or medical billing processes, PIP collections and reimbursement systems, and a strong background in ensuring compliance with PIP regulations.

Responsibilities:

  • Billing Strategy and Oversight:
  • Develop and implement effective billing strategies aligned with industry best practices.
  • Oversee the end-to-end billing process, ensuring accuracy and efficiency.
  • Review and verify medical billing information for accuracy and completeness.
  • Prepare and submit claims to insurance companies electronically or by mail.
  • Follow up on unpaid claims and denials, and resubmit as necessary.
  • Research and resolve billing discrepancies or issues.
  • Communicate with patients, insurance companies, and healthcare providers regarding billing inquiries or disputes.
  • Maintain patient confidentiality and adhere to all HIPAA regulations.
  • Personal Injury Protection (PIP):
  • Utilize extensive PIP experience to identify and prevent billing errors and fraudulent activities related to personal injury claims.
  • Collaborate with cross-functional teams to implement and optimize PIP initiatives.
  • Compliance and Regulatory Adherence:
  • Stay abreast of industry regulations and compliance requirements related to PIP and personal injury protections.
  • Implement and monitor processes to ensure adherence to PIP regulatory standards.
  • Team Leadership:
  • Lead and mentor the billing team, fostering a culture of accountability and continuous improvement.
  • Conduct regular training sessions to keep the team updated on PIP regulations, industry changes, and best practices.
  • Performance Analysis and Reporting:
  • Implement key performance indicators (KPIs) to measure billing performance in the context of PIP.
  • Generate regular reports for management, highlighting areas for improvement and success.
  • Collaboration:
  • Collaborate with other departments, such as operations, and IT, and human resources to streamline processes and resolve issues.

Estimated Salary: $80,000 - $110,000 per year.

Qualifications:

  • Bachelor's degree in Accounting, Finance, or a related field preferred.
  • Minimum of 20 years of experience in billing, with a focus on Personal Injury Protections (PIP).
  • Proven experience in a managerial or leadership role within billing operations.
  • Strong knowledge of PIP regulations, compliance requirements, collections, and reimbursement systems.
  • Excellent analytical and problem-solving skills.
  • Exceptional communication and interpersonal skills.
  • Proficient in using medical billing software and electronic health records (EHR) systems.
  • Knowledge of medical coding systems (such as CPT, ICD-10, HCPCS).
  • Familiarity with insurance guidelines and reimbursement processes.
  • Strong attention to detail and accuracy in data entry and record keeping.
  • Excellent communication skills, both written and verbal.
  • Ability to work independently and prioritize tasks effectively.

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