CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
Professional Review Analyst I
Location
United States
Posted
5 days ago
Salary
$19 - $31 / hour
Seniority
Mid Level
Job Description
Role Description
The Professional Review Analyst 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 remote role. Candidate must be located in the greater Charlotte, North Carolina Region and able to attend in office training for a minimum of 1 week at start of employment.
Essential Functions & Responsibilities:
- 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.
Qualifications
- 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).
Requirements
- Associate’s degree or equivalent experience.
- CPC or CPC-A required.
- Previous experience in the following areas preferred:
- Medical bill auditing.
- Knowledge of workers' compensation claims process.
- Prospective, concurrent and retrospective utilization review.
Benefits
- CorVel uses a market based approach to pay and our salary ranges may vary depending on your location.
- Pay Range: $19.24 - $31.04 per hour.
- A comprehensive benefits package is available for full-time regular employees and includes:
- Medical (HDHP) w/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.
- Paid time off.
Job Requirements
- 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).
- Associate’s degree or equivalent experience.
- CPC or CPC-A required.
- Previous experience in the following areas preferred:
- Medical bill auditing.
- Knowledge of workers' compensation claims process.
- Prospective, concurrent and retrospective utilization review.
Benefits
- CorVel uses a market based approach to pay and our salary ranges may vary depending on your location.
- Pay Range: $19.24 - $31.04 per hour.
- A comprehensive benefits package is available for full-time regular employees and includes:
- Medical (HDHP) w/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.
- Paid time off.
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