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CorVel Corporation · 1 month ago

Professional Review Specialist I

United States

Full-time

Remote

New Grad, Entry Level

$18.80/hr - $30.34/hr

CorVel Corporation is a national provider of industry-leading risk management solutions. The Professional Review Specialist analyzes medical services and billing across various claim types to evaluate the accuracy of charges and the medical necessity of care provided.

InsuranceSoftware

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

Additional duties as assigned

Qualification

ICD DiagnosesProcedure CodesC.P.T.Medical terminologyMicrosoft OfficeMedical bill auditingWorkers' compensation claimsTechnical aptitudeWork independently

Required

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 Office applications

Technical aptitude with the ability to expand knowledge of MedCheck's proprietary systems

Ability to work independently, follow process guidelines, and meet productivity standards and timelines (must maintain a score of 98% or higher on performance audits)

Associate's degree or equivalent experience

CPC or CPC-A required