Professional Review Analyst I

CorVel Corporation; Charlotte (NC); Hybrid; USD 45,000 - 80,000; Full time

Job summary

An established industry player is seeking a Professional Review Analyst to provide critical analysis of medical services and billing. This role involves assessing the appropriateness of charges on various medical bills and requires a strong understanding of medical terminology and coding. Candidates should be proficient in Microsoft applications and possess a CPC or CPC-A certification. The position offers the flexibility of remote work while requiring residency in the greater Charlotte area for training. Join a supportive and innovative company that values accountability and teamwork, and enjoy a comprehensive benefits package that promotes both personal and professional growth.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401K

Paid Time Off

Life Insurance

Long Term Disability

Flexible Spending Account Options

Health Savings Account

Qualifications

• Thorough knowledge of medical coding and terminology is essential.
• CPC or CPC-A certification required for this role.

Responsibilities

• Analyze medical bills to determine appropriateness of charges.
• Document work and conclusions in the designated computer program.

Skills

ICD Diagnoses and Procedure Codes

C.P.T.

Medical Terminology

Microsoft Applications

MedCheck’s Proprietary Systems

Independent Work

Productivity Standards

Education

Associate’s Degree

CPC or CPC-A Certification

Tools

MedCheck’s Proprietary Systems

Microsoft Applications

Job description

NC - Charlotte
3530 Toringdon Way
Suite 400
Charlotte, NC 28277, USA

The Professional Review Analyst provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills to determine appropriateness of medical care.

This position can be remote, but candidates must reside in the greater Charlotte, NC region and must be able to attend in-office training for a minimum of 1 week at the 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 the appropriateness of billing, delivery of care, and treatment plans.
• Appropriately document work and final conclusions in designated computer program.
• Requires regular and consistent attendance.
• Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP).
• 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 applications and technical aptitude with the ability to expand knowledge and proficiency in MedCheck’s proprietary systems.
• Ability to work independently, follow process guidelines, 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 required.
• Previous experience in the following areas preferred:
  • Medical bill auditing.
  • Knowledge of worker's compensation claims process.
  • Prospective, concurrent, and retrospective utilization review.

PAY RANGE:

CorVel uses a market-based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.), new hires may be slotted into a different level, either up or down, based on assessment during the interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

In general, our opportunities will be posted for up to 1 year from the date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CORVEL:

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 enables 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!).

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, and paid time off.

CorVel is an Equal Opportunity Employer, drug-free workplace, and complies with ADA regulations as applicable.