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- 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
- Requires regular and consistent attendance
- Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
- Additional duties as assigned
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- Knowledge of applicable fee schedule and or applicable U&C Guidelines
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- Ability to work independently, follow process guidelines, 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
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- Medical bill auditing
- Knowledge of worker's compensation claims process
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Professional Review Specialist II - East Hartford, United States - CorVel
Description
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 can be hybrid once employee is fully trained.ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
KNOWLEDGE & SKILLS:
EDUCATION & EXPERIENCE:
PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location.
Pay rates are established taking into account the following factors:
federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.
Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role.
Pay Range:
$ $34.04 per hour
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
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.
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.Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT).
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.
#LI-Hybrid