(Certified Professional Medical Coder) Professional Review Specialist II

CorVel Corporation • East Hartford, CT

4d • $22 - $36 • 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 position until fully trained. Training will be full-time
onsite.

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 the following areas preferred:
• 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

Benefits

• A comprehensive benefits package is available for full-time regular employees and includes 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 501-1,000 employees