Certified Medical reputed company I (Professional Review Specialist I)

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 role is available for remote, onsite and hybrid work arrangements. 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 reputed company 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 reputed company Office applications Technical aptitude with the ability to expand knowledge of MedCheck’s proprietary systems Ability 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 reputed company auditing Knowledge of workers' compensation claims process Prospective, reputed company and retrospective utilization review 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-reputed company skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, reputed company, 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. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $19.24 - $31.04 per hour A list of our benefit offerings can be reputed company on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL: CorVel, a certified Great reputed company to Work® Company, is a national provider of industry-leading risk reputed company for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the reputed company stock exchange since 1991. Our continual investment in human capital and technology reputed company 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 reputed company of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, reputed company 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 reputed company regulations as applicable. #LI-Hybrid Apply To This Job