Professional Review Specialist I

2 days ago

California, United States CorVel Corporation Full time

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 hybrid 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: $18.36 - $29.63 per hour

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

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

  • Clinical Research Specialist I

    6 days ago

    California, United States Cedars-Sinai Full time

    Job DescriptionCome join our teamThe Clinical Research Specialist I provides clinical research expertise by participating in the design and implementation of research projects as needed. Responsible for specific and assigned aspects of research infrastructure development, coordinates projects, and communicates status and improvement areas to leadership. May...

  • Clinical Research Specialist I

    2 weeks ago

    California, United States Cedars-Sinai Full time

    Job DescriptionCome join our teamThe Clinical Research Specialist I provides clinical research expertise by participating in the design and implementation of research projects as needed. Responsible for specific and assigned aspects of research infrastructure development, coordinates projects, and communicates status and improvement areas to leadership. May...

  • Provider Relations Specialist I

    4 weeks ago

    California, United States CorVel Corporation Full time

    CorVel is hiring a Provider Relations Specialist for the Irvine, CA office. The Provider Relations Specialist assists providers via phone and email with basic to complex bill review questions and requests. Documents bill review errors for tracking and trending to improve team error rate. Acts as a positive and professional representative of our CorVel...

  • Provider Relations Specialist I

    1 month ago

    California, United States CorVel Corporation Full time

    CorVel is hiring a Provider Relations Specialist for the Irvine, CA office. The Provider Relations Specialist assists providers via phone and email with basic to complex bill review questions and requests. Documents bill review errors for tracking and trending to improve team error rate. Acts as a positive and professional representative of our CorVel...

  • Bill Review Analyst I

    1 month ago

    California, United States CorVel Corporation Full time

    Responsible for review, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote position. Must reside in or near Folsom, CA. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines and PPO...

  • Bill Review Analyst I

    4 weeks ago

    California, United States CorVel Corporation Full time

    Responsible for review, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote position. Must reside in or near Folsom, CA. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines and PPO...

  • Bill Review Analyst I

    4 weeks ago

    California, United States CorVel Corporation Full time

    Responsible for review, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote position. Must reside in or near Folsom, CA. ESSENTIAL FUNCTIONS & RESPONSIBILITIES:Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines and PPO discounts...

  • Bill Review Analyst I

    1 month ago

    California, United States CorVel Corporation Full time

    Responsible for review, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote position. Must reside in or near Folsom, CA. ESSENTIAL FUNCTIONS & RESPONSIBILITIES:Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines and PPO discounts...

  • Bill Review Analyst I

    2 days ago

    California, United States CorVel Corporation Full time

    Responsible for review, auditing and data-entry of medical bills for multiple states and lines of business. This is a hybrid position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines and PPO discounts Position requires knowledge of...

  • Bill Review Analyst I

    2 days ago

    California, United States CorVel Corporation Full time

    Responsible for review, auditing and data-entry of medical bills for multiple states and lines of business. This is a hybrid position. Must reside in Folsom/Sacramento area. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines and PPO...

  • Health in All Policies Specialist | HEALTH PROGRAM SPECIALIST I

    3 weeks ago

    California, United States California Department of Public Health Full time

    Job Description and Duties There are two vacancies being advertised across multiple counties. The candidate will be headquartered in the county nearest the residence of the selected candidate. The counties are: * Sacramento or Contra Costa County * The Health Program Specialist I (HPS I) serves as a technical consultant and subject matter expert for the...

  • Plant Engagement Specialist

    2 weeks ago

    Tracy, California, United States O-I Full time

    Job DescriptionThe Plant Engagement Specialist will assist in the execution of staffing, payroll, performance management, employee development, training and succession planning. This hands-on position is responsible for providing strategic HR counsel and driving the implementation of HR processes and initiatives. The Engagement Specialist will:Train and...

  • Financial Care Specialist I

    4 weeks ago

    California, United States Cedars-Sinai Full time

    Job DescriptionAlign yourself with an organization that has a reputation for excellence Cedars-Sinai was awarded the National Research Corporation's Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company's Workplace of the Year. This annual award recognizes...

  • Financial Care Specialist I

    2 weeks ago

    California, United States Cedars-Sinai Full time

    Job DescriptionAlign yourself with an organization with a reputation for excellence Cedars-Sinai was awarded the National Research Corporation's Consumer Choice Award 19 times for providing the highest-quality medical care in Los Angeles. We were also awarded the Advisory Board Company's Workplace of the Year. We offer an outstanding benefits package that...

  • Financial Care Specialist I

    1 month ago

    California, United States Cedars-Sinai Full time

    Job DescriptionAlign yourself with an organization that has a reputation for excellence Cedars-Sinai was awarded the National Research Corporation's Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company's Workplace of the Year. This annual award recognizes...

  • I&i Supervisor

    4 days ago

    California, United States St. Mary's County Metropolitan Commission Full time

    **Job Summary**: Assists the Operations Department in the project management and administration of the Commission’s Inflow and Infiltration Programs and enforcement of the Sewer Use Regulation (SUR). Coordinates and manages Rehab Projects for the Maintenance and Collections Department. Supervises personnel responsible for Inflow and Infiltration programs...

  • Provider Relations Specialist I

    4 weeks ago

    California, United States CorVel Corporation Full time

    Assists providers via phone and email with basic to complex bill review questions and requests. Documents bill review errors for tracking and trending to improve team error rate. Acts as a positive and professional representative of our CorVel family; ensures compliance with company best practice standards; ensure consistent, timely delivery of our quality...

  • Provider Relations Specialist I

    1 month ago

    California, United States CorVel Corporation Full time

    Assists providers via phone and email with basic to complex bill review questions and requests. Documents bill review errors for tracking and trending to improve team error rate. Acts as a positive and professional representative of our CorVel family; ensures compliance with company best practice standards; ensure consistent, timely delivery of our quality...

  • Consultant Grade I

    2 weeks ago

    California, United States Guruji24 Full time

    Date of Examination Last Date :- Job location :- Total post : - (1) Consultant Grade I :- Master Degree in Science / Economics / Statistics / Operator Research / Public Polity / Development Studies / Business Administration / Management / BE B.Tech / MBBS / LLB / CA/ICWA from any Recognized University in India with 3 to 8 years of experience this post. (2)...

  • Content Manager

    4 weeks ago

    California, United States ARCH SOLAR C&I INC Full time

    Job Description for Promotional Review Editor (PRE) 100% on-site The PRE has three primary responsibilities: Complete an editorial review of promotional and internal materials for accuracy, quality, and compliance Perform a comment verification on documents to ensure Medical, Legal and Regulatory (MLR) advice was incorporated correctly Facilitate live...