CorVel

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 position until fully trained. Training will be full-time onsite. 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...

The Workers’ Compensation Claims Supervisor is responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures.The WC Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance, supporting the goals of the claims department and CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES Supervises WC claims staff in their day‑to‑day operations Assists Claims Manager with recruitment, interviewing and onboarding new staff, ensuring proficiency in procedures and job functions Ensures staff compliance with Workers’ Compensation laws and mandated regulatory reporting requirements Ensures optimal team performance through ongoing training, coaching and regular performance evaluations; recommends merit‑based actions (subject to managerial approval) Provides technical and jurisdictional guidance to claims...

Certified Professional Medical Coder - Professional Review Specialist II Job Category: Bill Review Requisition Number: CERTI011187 Locations East Hartford, CT 06108, USA Description 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 position until fully trained. Training will be full-time onsite. 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...

A healthcare solutions provider in East Hartford, CT seeks a Certified Professional Medical Coder - Professional Review Specialist II. This hybrid role involves analyzing medical billing to ensure accuracy and necessity of care provided. Successful candidates will have a strong understanding of ICD diagnoses, C.P.T., and experience in medical bill auditing. Join a dynamic team dedicated to delivering quality healthcare outcomes, with a comprehensive benefits package for full-time employees. #J-18808-Ljbffr

A healthcare solutions provider is seeking a DRG Coder/Clinical Auditor to perform critical validation reviews of medical records. Candidates must have an associate degree in nursing and current RN licensure, along with CCS or CIC certification. Responsibilities include ensuring accurate billing through meticulous audits and maintaining compliance with clinical documentation standards. This remote position offers a competitive pay range of $68,566 – $104,841 depending on factors such as location and skills. #J-18808-Ljbffr

CERIS Certified Coder I The CERIS Certified Coder reverse codes previously coded medical bills to determine coding accuracy. This role is responsible for making claim-related recommendations and communicating status of the claim to involved stakeholders. This is a remote position. Essential Functions & Responsibilities: Receives claim and processes based on state rules and regulations Determines validity and compensability of the claim using CorVel proprietary programs Makes recommendations and communicates claim status to 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 Maintain HIPAA compliance Additional duties as assigned Knowledge & Skills: Ability to learn rapidly to develop knowledge and understanding of claims practices Strong organizational skills Ability to meet or...

Medical Only Claims Supervisor The Workers' Compensation Claims Supervisor is responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. The WC Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance, supporting the goals of the claims department and CorVel. This is a remote role. Essential Functions & Responsibilities: Supervises WC claims staff in their day-to-day operations Assists Claims Manager with recruitment, interviewing, and onboarding new staff, ensuring proficiency in procedures and job functions Ensures staff compliance with Workers' Compensation laws and mandated regulatory reporting requirements Ensures optimal team performance through ongoing training, coaching, and regular performance evaluations; recommends merit-based actions (subject to managerial approval) Provides...

The Workers' Compensation Claims Supervisor is responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. The WC Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance, supporting the goals of the claims department and CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Supervises WC claims staff in their day-to-day operations Assists Claims Manager with recruitment, interviewing, and onboarding new staff, ensuring proficiency in procedures and job functions Ensures staff compliance with Workers' Compensation laws and mandated regulatory reporting requirements Ensures optimal team performance through ongoing training, coaching, and regular performance evaluations; recommends merit-based actions (subject to managerial approval) Provides technical and jurisdictional...

A healthcare solutions provider is seeking a CERIS Certified Coder to reverse code medical bills for accuracy. Key responsibilities include processing claims, determining their validity, and communicating with stakeholders. Essential qualifications include a High School diploma, AAPC certification, and experience in orthopedic billing. This position allows for remote work and offers a comprehensive benefits package, emphasizing growth and support for employees. #J-18808-Ljbffr