Professional Review Specialist II

Job Description

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.

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:

• A Certified Professional Coder (CPC) with the America Academy of Professional Coders (AAPC)
• 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: $21.67 - $34.86 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 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.

#LI-Hybrid