Certified Professional Coder - Professional Review Specialist II

About the role

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.

Essential Functions & 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

Knowledge & Skills

• 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
• Able to work independently, follow process guidelines, and meet productivity standards and timelines (must maintain a score of 98% or higher on performance audits)

Education & Experience

• Associate’s degree or equivalent experience
• CPC or CPC-A required
• Previous experience in the following areas preferred: Medical bill auditing, Knowledge of workers' compensation claims process, Prospective, concurrent and retrospective utilization review

Pay

Pay Range: $22.17 - $35.66 per hour

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.

About Corvel

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities.