Clinical Review Auditor I

1 week ago


Charlotte, North Carolina, United States CorVel Corporation Full time

The Healthcare Claims Evaluation Specialist is responsible for assessing medical services to ascertain the validity of charges on various medical invoices, ensuring the appropriateness of care provided.

Candidates must be situated in the greater Charlotte, NC area and be available for in-office training for a minimum of one week at the commencement of employment.

KEY RESPONSIBILITIES:

Determine the necessity of the review process and relay any specific concerns to the claims examiner or direct reporting manager. Gather relevant data and evaluate information to make informed decisions regarding the appropriateness of billing, care delivery, and treatment plans. Accurately document work and final assessments in the designated software. Regular and consistent attendance is required. Adhere to all safety protocols and regulations during work hours in alignment 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 applications and possess the technical aptitude to enhance knowledge and skills in CorVel's proprietary systems. Ability to work autonomously, adhere to process guidelines, and meet productivity standards and deadlines. (Must maintain a performance audit score of 98% or higher.)

EDUCATION & EXPERIENCE:

Associate's degree or equivalent experience is required. CPC or CPC-A certification is mandatory. Previous experience in the following areas is preferred: Medical bill auditing, understanding of the worker's compensation claims process, and prospective, concurrent, and retrospective utilization review.

COMPENSATION:

CorVel employs a market-based approach to compensation, and our salary ranges may differ based on your location. Pay rates are determined by considering federal, state, and local minimum wage requirements, geographic location differentials, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be adjusted at any time.

For leveled positions (I, II, III, Senior, Lead, etc.), new hires may be placed into a different level, either up or down, based on assessments during the interview process, taking into account 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 Range: $36.79 per hour.

A comprehensive list of our benefits can be found on the CorVel website: CorVel Careers | Opportunities in Risk Management.

About CorVel

CorVel, a certified Great Place to Work Company, is a national provider of leading risk management solutions for the workers' compensation, auto, health, and disability management sectors. Established in 1987 and publicly traded on the NASDAQ since 1991, our ongoing investment in human capital and technology allows us to deliver innovative and integrated solutions to our clients. We are a stable and growing organization with a strong, supportive culture and numerous career advancement opportunities. Over 4,000 employees across the United States uphold 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.



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