The PIP Lien Specialist supports the PIP Department by following the best practices associated with managing all aspects of the Medicare recovery process and healthcare liens more effectively and efficiently.
The position requires the lien specialist to work and communicate with the PIP Claims Representatives, PIP Supervisors, and other team members. The lien specialist also interacts with the Medicare Liaison, NJM policyholders, associated injured parties or their legal representatives, medical providers, and other departments within NJM, as needed.
Hours:
Monday to Friday 8AM- 5PM (Flexible start time with work from home opportunities after training).
To accomplish this, the PIP Lien Specialist will:
Maintain responsibility of all aspects of Medicare reporting to include responsibility of the monthly Medicare eligible list and quarterly error report.
Manage various queues within Claim Center, including the PIP Medicare Lien Queue and the PIP MSP Reporting Queue.
Respond to incoming Medicare and Healthcare liens. Evaluate the claim & determine the next course of action. Consult with assigned claim adjuster, NJM legal and Medicare liaison to address questions or issues if needed.
Prepare responses and issue reimbursement when required.
Maintain Claim Center activities to track open liens. Monitor success of defenses and raise recommendations as appropriate.
Monitor the MSPRC portal to obtain most up-to-date status for outstanding liens.
Review and triage monthly debt report, summarize areas of concern and forward to the PIP department administrators for review. Leverage the monthly debt report to monitor and track all open Medicare debts and ensure NJM responds timely.
Maintain up-to-date knowledge on Section 111 reporting and the Medicare Appeals Process to include seminars, monitoring the CMS website and meetings with the Medicare liaison.
Monitor the MSP Recovery portal at regular intervals for new submissions and consult with department manager to determine next steps.
Demonstrate knowledge in NJ and other states and apply policy language and regulatory requirements appropriately (into defenses).
Participate in special projects or initiatives and assume additional responsibilities as needed.
Participate in User Acceptance Testing to ensure appropriate system functionality after program upgrades.
Position Requirements (Skills, Traits & Experience)
A college degree or three years of claims experience is preferred.
Excellent verbal and written communication skills, knowledge of Microsoft suite and Adobe.
Strong organizational skills and decision-making capabilities.
Ability to multi-task, prioritize and use time efficiently.
Demonstrate accuracy and thoroughness.
Strong interpersonal and customer service skills.
Ability to work independently, and in a team environment. Proactive.
Willingness to learn and grow within the position.
Demonstrate reliability and conform to the company’s attendance policy.
Salary: $59,744 - $75,361 (Salary is commensurate with experience and credentials).
Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.