Provider Relations Sp I

CorVel Career Site•Folsom, CA

3d•Remote

About The Position

The Provider Relations Specialist assists providers via phone and email with bill review questions and requests of varying complexity. 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 consistent, timely delivery of our quality services. This role may be transitioned into a Knowledge Center Representative role within the first year of employment, based on business needs. While both the Provider Relations Specialist and the Knowledge Center Representative roles are customer support roles with overlapping core functions, specific responsibilities pertaining to only the Knowledge Center Rep role are marked as such in the below job description. This is a remote position.

Requirements

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
Ability to control phone calls to ensure timely resolution and lower provider hold times
Excellent verbal and written communication and interpersonal skills
Working knowledge of Microsoft Office (Word, Excel)

Nice To Haves

Associate’s degree preferred or comparable Workers Comp experience
Knowledge of assigned State’s Workers’ Comp regulations
CPC and/or expert in bill review analysis preferred

Responsibilities

Communicate clearly and professionally with providers and other stakeholders via phone and email
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
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
Provide administrative customer service assistance to claimants, providers, and other interested parties by answering telephonic inquiries with a focus on first-call resolution
Accurately capture and enter data into CareMC and other internal systems
Additional duties as assigned