Personal Injury Claims Specialist

4 weeks ago

Winter Park, Florida, United States Sterling Medical Group Full time
Job Title: Personal Injury Protection Specialist

Sterling Medical Group is a dynamic and rapidly growing healthcare organization committed to delivering exceptional services to our clients. We are seeking a highly skilled and experienced Personal Injury Protection Specialist to join our dedicated team.

Job Summary:

The Personal Injury Protection Specialist will play a crucial role in ensuring accurate and timely billing, compliance with regulatory requirements, and the implementation of efficient billing practices in the realm of personal injury. The ideal candidate will possess in-depth knowledge of auto insurance and/or medical billing processes, PIP (personal injury protection) collections and reimbursement systems, and a strong background in ensuring compliance with PIP regulations.

Responsibilities:

  • 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.
  • Collaborate with cross-functional teams to implement and optimize PIP initiatives.
  • 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.
  • 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.
  • 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.

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.

Sterling Medical Group is an equal opportunity employer and welcomes candidates from all similar managerial backgrounds to apply.

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