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Medical Billing Review Analyst

2 months ago


Charlotte, North Carolina, United States CorVel Healthcare Corporation Full time
Position Overview

The Medical Billing Review Analyst is responsible for evaluating healthcare services to assess the validity of charges on various medical invoices, ensuring the appropriateness of care provided.

Candidates must be located in the greater Charlotte, NC region and able to attend in-office training for a minimum of 1 week at the start of employment.

KEY RESPONSIBILITIES:

  • Determine the necessity of the review process and communicate any specific concerns to the claims examiner or direct reporting manager.
  • Gather supporting documentation and analyze data to make informed decisions regarding the validity of billing, care delivery, and treatment plans.
  • Accurately document work and final determinations in the designated software.
  • Maintain regular and consistent attendance.
  • Adhere to all safety protocols and regulations during work hours in accordance with the Injury and Illness Prevention Program (IIPP).
  • Perform additional duties as assigned.

REQUIRED KNOWLEDGE & SKILLS:

  • Comprehensive understanding of ICD Diagnoses and Procedure Codes, as well as C.P.T., along with a solid grasp of medical terminology.
  • Familiarity with applicable fee schedules and/or relevant U&C Guidelines.
  • Proficient in Microsoft Office applications and possess the technical aptitude to enhance knowledge and proficiency in proprietary systems.
  • Ability to work independently, adhere to process guidelines, and meet productivity standards and deadlines. (Must maintain a score of 98% or higher on performance audits).

EDUCATIONAL REQUIREMENTS:

  • Associate's degree or equivalent experience.
  • CPC or CPC-A certification is required.
  • Preferred previous experience in:
    • Medical billing audits.
    • Understanding of the worker's compensation claims process.
    • Utilization review processes including prospective, concurrent, and retrospective reviews.

COMPENSATION:

CorVel employs a market-based approach to compensation, and salary ranges may vary based on geographic location. Pay rates are determined by factors such as federal, state, and local minimum wage laws, geographic differentials, job-related skills, experience, qualifications, internal equity, and market conditions. Salary ranges may be adjusted at any time.

For leveled positions (I, II, III, Senior, Lead, etc.), new hires may be assigned to a different level based on assessment during the interview process, considering experience, qualifications, and overall fit for the role. The level may influence the salary range, and these adjustments will be clarified during the offer process.

Pay Rate: $36.79 per hour

For a comprehensive list of our benefits, please visit the CorVel website.

About CorVel Healthcare Corporation

CorVel is a nationally recognized provider of innovative risk management solutions across the workers' compensation, auto, health, and disability management sectors. Established in 1987 and publicly traded since 1991, we prioritize investment in human capital and technology to deliver integrated solutions to our clients. Our supportive culture fosters career advancement opportunities for over 4,000 employees nationwide, who embody our core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT).

A comprehensive benefits package is available for full-time regular employees, including Medical (HDHP) with 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, maintains a drug-free workplace, and complies with ADA regulations as applicable.