Professional Review Specialist I

CorVel; Folsom (CA); Remote; USD 60,000 - 80,000; Full time

Job summary

An innovative company is seeking a Professional Review Specialist to analyze medical services and ensure the appropriateness of charges. This remote role involves reviewing medical bills, documenting findings, and communicating with claims examiners. Ideal candidates will possess thorough knowledge of medical codes and terminology, along with strong analytical skills. Join a stable and growing organization that values accountability, commitment, and teamwork, while offering opportunities for career advancement and a comprehensive benefits package. If you are passionate about making a difference in the healthcare industry, this position is perfect for you.

Benefits

Medical insurance

Dental insurance

Vision insurance

401K

Paid time off

Flexible Spending Account

Long Term Disability

Life Insurance

Accident Insurance

Critical Illness Insurance

Qualifications

• Requires an Associate's degree or equivalent experience.
• CPC or CPC-A certification is mandatory.

Responsibilities

• Analyze medical bills to determine appropriateness of charges.
• Document findings and communicate issues to relevant parties.

Skills

ICD Diagnoses and Procedure Codes

C.P.T. knowledge

Medical terminology

Microsoft applications

Analytical skills

Independent work

Education

Associate's degree

CPC or CPC-A certification

Tools

MedCheck's proprietary systems

Job description

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

This is a remote position.

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.
• 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 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 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.

Pay Range: $18.80 - $30.34 per hour.

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management.

In general, our opportunities will be posted for up to 1 year from 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.

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