Certified Professional Coder - Professional Review Specialist II

CorVel Career Site•East Hartford, CT

5d•Hybrid

About The Position

The Professional Review Specialist analyzes medical services and billing across various claim types to evaluate the accuracy of charges and the medical necessity of care provided. This is a hybrid role. Training is onsite Full Time, then Hybrid once trained.

Requirements

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 Office applications
Technical aptitude with the ability to expand knowledge of MedCheck’s proprietary systems
Ability to work independently, follow process guidelines, and meet productivity standards and timelines (must maintain a score of 98% or higher on performance audits)
Associate’s degree or equivalent experience
CPC or CPC-A required

Nice To Haves

Medical bill auditing
Knowledge of workers' compensation claims process
Prospective, concurrent and retrospective utilization review

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
Additional duties as assigned