CorVel Healthcare Corporation

Job DescriptionJob DescriptionThe 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 remote role.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 managerCollect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plansAppropriately document work and final conclusions in designated computer programAdditional duties as assignedKNOWLEDGE & SKILLS:Thorough knowledge of ICD Diagnoses and Procedure Codes, and C.P.T., as well as an understanding of medical terminologyKnowledge of applicable fee schedule and or applicable U&C GuidelinesProficient in Microsoft Office applicationsTechnical aptitude with the ability to expand knowledge of...

Job Description Job Description CERIS is seeking a Certified Coder. The CERIS Certified Coder reverse code previously coded medical bills to determine coding accuracy. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim and processes based on state rules and regulations Determine validity and compensability of the claim using CorVel proprietary programs Make recommendations to referring office Communicate claim status with referring office Read and comprehend all medical reports Adhere to client and carrier guidelines and participate in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Additional duties/responsibilities as assigned Comply with all safety rules/regulations, in conjunction with the Injury and Illness Prevention Program (“IIPP”), as well as, maintain HIPAA compliance KNOWLEDGE & SKILLS: Ability to learn rapidly to develop knowledge and...