Professional Review Specialist (Remote)

2 days left

Employer
CorVel Corporation
Location
Tampa, Florida
Salary
Not Specified
Posted
Dec 01, 2022
Closes
Jan 30, 2023
Ref
6745807#GIJtoGJS.1
Industry
Insurance
Category
Insurance

The Professional Review Specialist/Nurse provides high level analysis of medical services to determine appropriateness of charges on medical bills associated with worker's compensation claims. This position is fully remote, full time position. This role is going to be dedicated to FL jurisdiction workers compensation billings.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

  • Complete approximately 50 bill audits daily.
  • Identify appropriateness of charges and associated coding on bills assigned daily.
  • Calculate and apply savings associated with reviews.
  • Communicate findings with stakeholders and supervision.
  • Comply with customer special handling and jurisdictional guidelines.
  • Utilize written and online resources support good decision making.
  • Utilize review system to appropriately document work and conclusions.
  • 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

KNOWLEDGE & SKILLS:

  • Thorough knowledge of ICD Diagnoses and CPT codes, as well as an understanding of general medical terminology
  • Experience with Florida's Worker's Compensation Fee Schedule and law is preferred.
  • Basic understanding of Medicare billing rules and guidelines.
  • Excellent written and verbal communication skills.
  • Strong quantitative reasoning skills.
  • Strong independent research capabilities.
  • Knowledge of applicable fee schedule and or applicable U&C Guidelines
  • Proficient in Microsoft Office applications.
  • Good technical aptitude with ability to learn and use software tools and resources (proprietary and otherwise).
  • Strong ability to multi-task.
  • Must maintain high quality output at all time.

EDUCATION/EXPERIENCE:

  • Certified Professional Coder (CPC) Accreditation by the American Academy of Professional Coders (AAPC) or equivalent accreditation by another nationally recognized coding organization and/or 2+ years of coding and data entry experience.
  • Associate's degree or equivalent experience
  • RN is preferred.
  • Previous experience in the following areas preferred:
    • Medical bill auditing
    • Knowledge of worker's compensation claims process
    • Prospective, concurrent and retrospective utilization review

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. 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.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

#LI-Remote

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