Professional Review Specialist I

The Professional Review Specialist, certified medical coder, including RN, provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills to determine appropriateness of medical care.Candidates must be located in the greater Charlotte, NC region and able to attend in office training for a minimum of 2 weeks 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 managerCollect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plansAppropriately document work and final conclusions in designated computer programRequires regular and consistent attendanceComply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)Additional duties as assignedKNOWLEDGE & SKILLS:Thorough knowledge of ICD Diagnoses and Procedure Codes, and C.P.T., as well as an understanding of medical terminologyKnowledge of applicable fee schedule and or applicable U&C GuidelinesProficient in Microsoft applications and technical aptitude with ability to expand knowledge and proficiency in MedCheck's proprietary systemsAbility 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 experienceCPC or CPC-A requiredPrevious experience in the following areas preferred:Medical bill auditingKnowledge of worker's compensation claims processProspective, concurrent and retrospective utilization reviewPAY 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: $22.81 - $36.79 per hourA list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk ManagementAbout CorVelCorVel, 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!).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.

Created: 2024-11-02