The Professional Review Specialist analyzes medical services and billing across various claim types to evaluate the accuracy of charges and the medical necessity of care provided.
This is a hybrid position until fully trained. Training will be full-time onsite.
- Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and/or direct reporting manager
- Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans
- Appropriately document work and final conclusions in designated computer program
- Additional duties as assigned
Knowledge & Skills:
- Thorough knowledge of ICD Diagnoses and Procedure Codes, and C.P.T., as well as an understanding of medical terminology
- Knowledge of applicable fee schedule and/or applicable U&C Guidelines
- Proficient in Microsoft Office applications
- Technical aptitude with the ability to expand knowledge of MedCheck's proprietary systems
- Ability to work independently, follow process guidelines, and meet productivity standards and timelines (must maintain a score of 98% or higher on performance audits)
Education & Experience:
- Associate's degree or equivalent experience
- CPC or CPC-A certification required
- Previous experience preferred in medical bill auditing, workers' compensation claims process, and utilization review (prospective, concurrent, retrospective)
CorVel uses a market based approach to pay; pay ranges may vary by location. Pay Range: $22.17 - $35.66 per hour
Benefits include Medical (HDHP) with Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel is a certified Great Place to Work® Company and an Equal Opportunity Employer, drug free workplace, compliant with ADA regulations as applicable.
- Associate's degree or equivalent experience
- Certified Professional Coder (CPC or CPC-A) required
- Knowledge of ICD Diagnoses, CPT coding, medical terminology
- Experience in medical bill auditing and workers' compensation claims process preferred
- Ability to independently analyze and document medical review findings
- Proficiency with Microsoft Office and proprietary systems
- Strong adherence to productivity standards and accuracy (minimum 98% on performance audits)
Comprehensive benefits package including Medical (HDHP) with Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
Location
Connecticut, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 month ago