Professional Review Specialist II

1 month ago

East Hartford, United States CorVel 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 position can be hybrid once employee is fully trained.

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: $21.16 - $34.04 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

  • Professional Review Specialist II

    1 month ago

    East Hartford, United States CorVel Healthcare Corporation Full time

    Job DescriptionJob DescriptionThe 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 position can be hybrid once employee is fully trained.ESSENTIAL FUNCTIONS & RESPONSIBILITIES:Identify the necessity of the review...

  • Professional Review Specialist II

    1 month ago

    Hartford, Connecticut, 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 position can be hybrid once employee is fully trained. ESSENTIAL FUNCTIONS & RESPONSIBILITIES:Identify the necessity of the review process and communicate any...

  • Professional Review Specialist II

    1 month ago

    Hartford, 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 position can be hybrid once employee is fully trained. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate...

  • Template Optimization Specialist

    1 month ago

    Hartford, United States Hartford Healthcare Full time

    Work where every moment matters. Every day, over 30,000 Hartford HealthCare employees come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network. Hartford HealthCare Medical Group is one of the largest medical practices in New England...

  • Customer Experience Specialist Ii

    7 days ago

    Hartford, United States Broan-NuTone LLC Full time

    Broan-NuTone leads the residential ventilation industry in North America with our innovative products, fulfilling our mission to improve people’s lives through better air. We are present in more than 110 million homes in North America and are proud to move almost 13 trillion cubic feet of fresh air per year. Our 2,000+ entrepreneurs operate in four...

  • Mechanic II

    3 weeks ago

    East Hartford, Connecticut, United States Lowe's Full time

    What You Will Do The focus of the maintenance team is to keep equipment in the Regional Distribution Center (RDC) fully operational. The Maintenance Mechanic II is a knowledgeable repair person with exposure to and experience with RDC systems and building components. The Maintenance Mechanic II has specialist knowledge and complex repair capability in two of...

  • Template Optimization Specialist

    3 weeks ago

    Hartford, United States Hartford Healthcare Full time

    Description Job Schedule: Full Time Standard Hours: 40 Job Shift: Shift 1 Shift Details: Mon-Fri Work where every moment matters. Every day, over 30,000 Hartford HealthCare employees come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticuts most comprehensive healthcare...

  • QA Validation Specialist

    2 weeks ago

    East Greenbush, United States Regeneron Pharmaceuticals Inc. Full time

    The QA Validation department is hiring! This team supports validation of equipment, utilities, software, cleaning and sterilization processes at Regeneron’s Rensselaer facility in accordance with regulatory requirements implementing company manufacturing standard policies and procedures. **In this role, a typical day may include**: Generates, executes...

  • Collections Specialist

    3 weeks ago

    East Hartford, United States Up Realty Full time

    **Collections Specialist Job Description**: Our company is looking for an experienced and motivated collections specialist to join our dynamic team. Your duties will include reviewing past due client accounts, collecting overdue payments, assisting in the legal process of debt collections as well as performing routine collections practices. The role...

  • Behavioral Health Specialist II

    1 month ago

    East Providence, United States Lifespan Corporation Full time

    Summary: Under the direction of Clinical Nurse Manager (Inpatient)/Program Director (Partial) and Unit Charge RN the Behavioral Health Specialist II (BHS II) is responsible for providing care and safety to children and adolescents as a member of the interdisciplinary treatment team. The BHS II is responsible for input into the formulation of the day-to-day...

  • Cps and Foster Care

    3 weeks ago

    Hartford, United States Departmental Specialist 13 - Project Excellence New Full time

    **Salary** - $49,795.20 - $81,931.20 Annually**Location** - Hartford, MI**Job Type** - Permanent Full Time**Job Number** - SS - VAN BUREN**Department** - Health and Human Services - Counties**Opening Date** - 06/17/2024**Bargaining Unit** - UNITED AUTO WORKERS (UAW)The Services Specialist will utilize child welfare practice skills to ensure children are...

  • IT Support Specialist II

    2 weeks ago

    East Lansing, Michigan, United States MiHIN Full time

    **IT Support Specialist II** Remote - East Lansing, MI **Position Purpose** The IT Support Specialist works as part of the Infrastructure team and is responsible for the support, administration, and implementation of the company's desktops, laptops, cloud servers, applications, and cloud networking. The IT Support Specialist also supports the MiHIN help...

  • IT Support Specialist II

    2 weeks ago

    East Lansing, United States MiHIN Full time

    **IT Support Specialist II** Remote - East Lansing, MI **Position Purpose** The IT Support Specialist works as part of the Infrastructure team and is responsible for the support, administration, and implementation of the company's desktops, laptops, cloud servers, applications, and cloud networking. The IT Support Specialist also supports the MiHIN help...

  • Operations Specialist

    2 months ago

    Hartford, United States Talon Professional Services Full time

    (but are not limited to): Monitor the Daily CCT Workday Report and add any new entries to the Monthly Working List. Work the current month's Working List daily to make sure all tasks are complete for each employee. Provide proper documentation to the Operations, Specialist, Operation, Manufacturing, Staffing, Skills

  • Mechanic II

    1 month ago

    Hartford, United States Lowe's Companies Full time

    What You Will Do The focus of the maintenance team is to keep equipment in the Regional Distribution Center (RDC) fully operational. The Maintenance Mechanic II is a knowledgeable repair person with exposure to and experience with RDC systems and building components. The Maintenance Mechanic II has specialist knowledge and complex repair capability in...

  • Mechanic II

    4 weeks ago

    Hartford, United States Lowe's Companies Full time

    Weekend shift What You Will Do The focus of the maintenance team is to keep equipment in the Regional Distribution Center (RDC) fully operational. The Maintenance Mechanic II is a knowledgeable repair person with exposure to and experience with RDC systems and building components. The Maintenance Mechanic II has specialist knowledge and complex repair...

  • Transaction Processing Associate Ii

    3 weeks ago

    East Hartford, United States Conduent State Healthcare, LLC Full time

    Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is...

  • Mechanic II

    1 month ago

    Hartford, United States Lowe's Full time

    What You Will Do The focus of the maintenance team is to keep equipment in the Regional Distribution Center (RDC) fully operational. The Maintenance Mechanic II is a knowledgeable repair person with exposure to and experience with RDC systems and building components. The Maintenance Mechanic II has specialist knowledge and complex repair capability in two of...

  • Mechanic II

    1 month ago

    Hartford, United States Lowe's Full time

    Weekend shift What You Will Do The focus of the maintenance team is to keep equipment in the Regional Distribution Center (RDC) fully operational. The Maintenance Mechanic II is a knowledgeable repair person with exposure to and experience with RDC systems and building components. The Maintenance Mechanic II has specialist knowledge and complex repair...

  • Mechanic II

    2 weeks ago

    Hartford, Connecticut, United States Lowe's Full time

    What You Will Do The focus of the maintenance team is to keep equipment in the Regional Distribution Center (RDC) fully operational. The Maintenance Mechanic II is a knowledgeable repair person with exposure to and experience with RDC systems and building components.The Maintenance Mechanic II has specialist knowledge and complex repair capability in two of...