Professional Review Analyst I

Professional Review Analyst I

The Professional Review Analyst 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. Candidate must be located in the greater Charlotte, North Carolina Region and able to attend in-office training for a minimum of 1 week at start of employment.

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 workers' 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. Pay Range: $19.24 - $31.04 per hour

A list of our benefit offerings can be found 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.

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