Appeals Team Lead
About The Position
The Appeals Team Lead assists injured workers, claims examiners, attorneys, providers, etc. in locating providers within the medical provider network (MPN), verifying provider inclusion in an MPN and scheduling appointments upon request for the injured worker. This position includes a moderate volume of inbound calls and a high volume of outbound calls. This role is responsible for documenting bill review errors to improve team error rate trend. The Provider Relations Specialist acts as a positive and professional representative of our CorVel family. The role ensures compliance with company best practice standards while also enabling a consistent, timely delivery of our quality services. This is a remote position.
Requirements
- Excellent oral and written communication skills
- Working knowledge of Microsoft Office (Word, Excel)
- Strong knowledge of fee schedule and network contracts
- Strong customer service skills and experience
- Strong organizational skills
- Ability to work independently and in a team environment
- Effective quantitative, analytical and interpretive skills
- Strong interpersonal, time management and analytical skills
- Ability to control phone calls to ensure timely resolution and lower provider hold times
- Associates’ degree preferred or comparable Workers Comp experience
- Knowledge of assigned State’s Workers’ Comp regulations
Nice To Haves
- CPC and/or expert in bill review analysis preferred
- Call center experience a plus but not required
Responsibilities
- Receive incoming calls, emails and faxes from the Medical Access Assistant line
- Communicate clearly and professionally with providers and other stakeholders via phone and email
- Provide excellent customer service and act as network liaison to injured workers, claims examiners and providers
- Understand Workers Compensation guidelines and various client contract language to interpret and support our bill review
- Navigate the bill review application to obtain accurate information for the callers
- Triage requests and ensure they are completed within required timeframes
- Locate providers of a particular specialty within a designated area as requested by the caller
- Verify providers are within a specified network and/or have a contract with CorVel
- Schedule appointments for injured workers upon request
- Assist callers in navigating our website directory
- Call providers to verify demographic information (address, phone number, WC acceptance, etc)
- Answer questions from callers regarding their MPN; transferring the caller to the appropriate department if we are unable to assist
- Work with the Network Relations team to correct any discrepancies in the database
- Communicate to the contract developers if there is a need for certain specialties in a geographic area
- Understand CorVel EORs as well as client-specific nuances
- Answer basic to complex State WC fee schedule and/or billing questions on processed medical bills covering regular as well as facility bill types
- Understand and be able to properly explain provider contracted rates, and carve-outs applied to medical bills
- Additional duties as assigned
Benefits
- 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
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
