Remote Revenue Cycle Specialist: Claims & Repricing

CorVel Corporation; Fort Worth (TX); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401K

Job summary

CorVel Corporation is seeking a Revenue Cycle Specialist to analyze and monitor claims audit data across multiple platforms, ensuring accurate reimbursement and resolving variances with internal and external partners.

The role requires strong knowledge of claims processing, DRG validation, CMS guidelines, and ICD-10 coding, plus proficiency in Microsoft Office. This is a remote position with a comprehensive benefits package.

Qualifications

• 3+ years of relevant experience or equivalent combination of education and work experience
• Claims repricing, pricing configuration, or provider maintenance experience required
• High School Diploma or equivalent required

Responsibilities

• Analyze and adjust/reprice claims to ensure accurate reimbursement rates
• Establish pricing structures and rules for pricing strategies across claims
• Identify errors in reconciliation files across multiple workflows and sites
• Perform contract and reimbursement variance analysis
• Analyze claims data to identify overpayments and billing errors
• Gather complex information from financial, clinical and operational systems
• Stay current on billing protocols and regulations
• Provide subject matter expertise on billing and coding guidelines
• Apply internal/external billing protocols to repricing for cost savings
• Identify opportunities to improve policies and procedures for efficiency
• Maintain documentation of analysis and data sources
• Analyze all Revenue Cycle transactions
• Run standard Revenue Cycle reports for stakeholders
• Produce evaluations and reports showing drivers of variances
• Support Product and Account Management with trend analyses
• Ensure confidentiality of all medical records, PHI, and PII
• Additional duties as assigned

Skills

Claims processing

DRG Validation

CMS guidelines

ICD-10 coding

Pay reimbursement

Microsoft Office

Independent worker

Analytical thinking

Detail oriented

Education

High School Diploma or equivalent

Job description

CorVel Corporation is seeking a Revenue Cycle Specialist to analyze and monitor claims audit data across multiple platforms, ensuring accurate reimbursement and resolving variances with internal and external partners.

The role requires strong knowledge of claims processing, DRG validation, CMS guidelines, and ICD-10 coding, plus proficiency in Microsoft Office. This is a remote position with a comprehensive benefits package.