Talent.com
Professional Review Specialist II (Certified Professional Medical Coder)
Professional Review Specialist II (Certified Professional Medical Coder)CorVel Healthcare Corporation • East Hartford, CT, US
Professional Review Specialist II (Certified Professional Medical Coder)

Professional Review Specialist II (Certified Professional Medical Coder)

CorVel Healthcare Corporation • East Hartford, CT, US
2 days ago
Job type
  • Full-time
Job description

Job Description

Job 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 will be in our Hartford, CT office during training, and once fully trained transitioned to a hybrid work arrangement.

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 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 bill auditing

  • Knowledge of worker's compensation claims process
  • Prospective, concurrent 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-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. The level may impact the salary range and these adjustments would be clarified during the offer process

    Pay Range : $24.90 - $34.86 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. 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-Hybrid

    Create a job alert for this search

    Professional Review Specialist Ii • East Hartford, CT, US

    Related jobs
    Physician (MD / DO) - Internal Medicine - General / Other in East Lyme, CT

    Physician (MD / DO) - Internal Medicine - General / Other in East Lyme, CT

    LocumJobsOnline • East Lyme, CT, US
    Full-time +1
    LocumJobsOnline is working with The Inline Group to find a qualified Internal Medicine MD in East Lyme, Connecticut, 06333!. Work Weeks | Monday - Friday No Evenings.New Graduates Welcome to Apply.A...Show more
    Last updated: 30+ days ago • Promoted
    Travel Nurse RN - OR - Operating Room

    Travel Nurse RN - OR - Operating Room

    PRIDE Health • Willimantic, CT, US
    Full-time
    PRIDE Health is seeking a travel nurse RN OR - Operating Room for a travel nursing job in Willimantic, Connecticut.Job Description & Requirements. PRIDE Health is the minority-owned healthcare r...Show more
    Last updated: 4 days ago • Promoted
    Diagnostic Imaging Manager - Quick Care (Hiring Immediately)

    Diagnostic Imaging Manager - Quick Care (Hiring Immediately)

    Middlesex Health • Old Saybrook, CT, US
    Full-time
    The Radiology Coordinator supervises, coordinates and oversees the daily operations, workflow, customer service and quality control of imaging services within the Urgent Care modality.Essential Dut...Show more
    Last updated: 30+ days ago • Promoted
    Travel Medical-Surgical Telemetry RN

    Travel Medical-Surgical Telemetry RN

    Anders Group • Palmer, MA, US
    Full-time
    Anders Group is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Palmer, Massachusetts.Job Description & Requirements. Pay package is based on 12 hour shifts and 36 hou...Show more
    Last updated: 30+ days ago • Promoted
    Locum Physician (MD / DO) - Internal Medicine - General / Other in Essex, CT

    Locum Physician (MD / DO) - Internal Medicine - General / Other in Essex, CT

    LocumJobsOnline • Essex, CT, US
    Full-time +1
    LocumJobsOnline is working with Weatherby Healthcare to find a qualified Internal Medicine MD in Essex, Connecticut, 06426!. Interested? Give Weatherby a call today and speak with one of our special...Show more
    Last updated: 23 days ago • Promoted
    Travel Medical-Surgical Telemetry RN - $2,314 per week

    Travel Medical-Surgical Telemetry RN - $2,314 per week

    PRIDE Health • Palmer, MA, United States
    Full-time
    PRIDE Health is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Palmer, Massachusetts.Job Description & Requirements. Pay package is based on 12 hour shifts and 36.Posted ...Show more
    Last updated: 30+ days ago • Promoted
    Travel Nurse RN - OR - Operating Room - $2,720 per week

    Travel Nurse RN - OR - Operating Room - $2,720 per week

    PRIDE Health • Willimantic, CT, United States
    Full-time
    PRIDE Health is seeking a travel nurse RN OR - Operating Room for a travel nursing job in Willimantic, Connecticut.Job Description & Requirements. PRIDE Health is the minority-owned healthcare recru...Show more
    Last updated: 5 days ago • Promoted
    RN Supervisor

    RN Supervisor

    Shady Knoll Center for Health & Rehabilitation • Milford, CT, US
    Full-time
    National Health Care Associates is proud to welcome the Shady Knoll Center for Health & Rehabilitation to our affiliate family!. We think that you are going to love it here.Your work will be mea...Show more
    Last updated: 10 days ago • Promoted
    Travel Medical-Surgical Telemetry RN

    Travel Medical-Surgical Telemetry RN

    Olaro • Palmer, MA, US
    Full-time
    Olaro is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Palmer, Massachusetts.Job Description & Requirements. Pay package is based on 12 hour shifts and 36 hours per ...Show more
    Last updated: 30+ days ago • Promoted
    Travel Telemetry RN

    Travel Telemetry RN

    Medical Solutions • Palmer, MA, US
    Full-time
    Medical Solutions is seeking a travel nurse RN Telemetry for a travel nursing job in Palmer, Massachusetts.Job Description & Requirements. We’re seeking talented healthcare professionals w...Show more
    Last updated: 30+ days ago • Promoted
    Travel Nurse RN - OR - Operating Room - $2,766 per week

    Travel Nurse RN - OR - Operating Room - $2,766 per week

    Coast Medical Service • Willimantic, CT, United States
    Full-time
    Coast Medical Service is seeking a travel nurse RN OR - Operating Room for a travel nursing job in Willimantic, Connecticut. Job Description & Requirements.Coast Medical Service is a nationwide trav...Show more
    Last updated: 30+ days ago • Promoted
    Travel Medical-Surgical Telemetry RN - $2,248 per week

    Travel Medical-Surgical Telemetry RN - $2,248 per week

    Anders Group • Palmer, MA, United States
    Full-time
    Anders Group is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Palmer, Massachusetts.Job Description & Requirements. Pay package is based on 12 hour shifts and 36 hours p...Show more
    Last updated: 30+ days ago • Promoted
    Travel Medical-Surgical Telemetry RN

    Travel Medical-Surgical Telemetry RN

    PRIDE Health • Palmer, MA, US
    Full-time
    PRIDE Health is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Palmer, Massachusetts.Job Description & Requirements. Pay package is based on 12 hour shifts and 36.PRI...Show more
    Last updated: 30+ days ago • Promoted
    Travel Medical-Surgical Telemetry RN - $2,368 per week

    Travel Medical-Surgical Telemetry RN - $2,368 per week

    Coast Medical Service • Palmer, MA, United States
    Full-time
    Coast Medical Service is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Palmer, Massachusetts. Job Description & Requirements.Coast Medical Service is a nationwide travel...Show more
    Last updated: 30+ days ago • Promoted
    RN Supervisor

    RN Supervisor

    Stone Bridge Center for Health & Rehabilitation • Milford, CT, US
    Full-time
    A Great Place to Work National Health Care Associates is proud to welcome the Stone Bridge Center for Health & Rehabilitation to our affiliate family! We think that you are going to love it here.Yo...Show more
    Last updated: 3 days ago • Promoted
    Travel Nurse RN - Oncology - $1,949 to $2,160 per week in New Haven, CT

    Travel Nurse RN - Oncology - $1,949 to $2,160 per week in New Haven, CT

    TravelNurseSource • New Haven, Connecticut, US
    Full-time
    TravelNurseSource is working with LRS Healthcare to find a qualified Oncology RN in New Haven, Connecticut, 06510!.Ready to start your next travel adventure? LRS Healthcare offers a full benefits p...Show more
    Last updated: 30+ days ago • Promoted
    MRI Technologist

    MRI Technologist

    Midstate Radiology Associates • Wallingford, CT, US
    Full-time
    Join Midstate Radiology Associates (MRA) as a 1st Shift, Full-Time, MRI Technologist at our Wallingford Imaging location. Position Schedule : Wed, Fri, & Sat.Compensation : MRA offers competitive ...Show more
    Last updated: 30+ days ago • Promoted
    Travel Medical-Surgical Telemetry RN - $2,428 per week

    Travel Medical-Surgical Telemetry RN - $2,428 per week

    Olaro • Palmer, MA, United States
    Full-time
    Olaro is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in Palmer, Massachusetts.Job Description & Requirements. Pay package is based on 12 hour shifts and 36 hours per week...Show more
    Last updated: 30+ days ago • Promoted