Professional Review Specialist II (Certified Professional Medical Coder)

CorVel • East Hartford, CT

69d • $24 - $34 • Hybrid

About The Position

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 will be in our Hartford, CT office during training, and once fully trained transitioned to a hybrid work arrangement.

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

• Previous experience in medical bill auditing
• Knowledge of worker's compensation claims process
• Experience in 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

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
• Paid time off

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees