Certified Medical Coder 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.

• 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

• 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

• 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)

• Prospective, concurrent and retrospective utilization review

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!).