Qureos Mentor

CorVel Corporation

<div>The Diagnostic Related Groups (DRG) Clinical Supervisor is responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves completing medical review forms, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination.

This is a remote position.

ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:
<ul>
<li>Supervises all daily activities of the DRG Clinical Auditors</li>
<li>Demonstrated knowledge of, ICD-10-CM and PCS codes, and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid with the ability to work independently with minimal supervision and demonstrate initiative</li>
<li>Completes DRG audits as needed</li>
<li>Responsible for the overall integrity of the quality of diagnosis and procedure codes verified by the clinical review nurses, for inpatient records and documentation received with the accompanied claim</li>
<li>Responsible for holding the DRG Clinical Auditors to the quota and error/accuracy rate</li>
<li>Assists with team coverage and provide support when needed</li>
<li>May be required to travel overnight and attend meetings or training</li>
<li>Additional duties as assigned</li></ul> 


KNOWLEDGE &amp; SKILLS:
<ul>
<li>Clinical knowledge of medical necessity rules</li>
<li>Working knowledge of HIPAA Privacy and Security Rules</li>
<li>Ability to build strong working relationships both internally and externally</li>
<li>Strong attention to detail</li>
<li>Must possess problem solving, critical thinking skills</li>
<li>Minimal typing experience</li>
<li>Excellent written and verbal communication skills</li>
<li>Ability to think and work independently, while working in an overall team environment</li>
<li>Ability to work in a fast paced/production environment</li>
<li>Proficient in Microsoft Office applications</li></ul> 


EDUCATION &amp; EXPERIENCE:
<ul>
<li>N./L.V.N. preferred</li>
<li>CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS</li>
<li>Proficient in Medicare, CMS guidelines and ICD-10 coding guidelines</li>
<li>Minimum of 3-5 years of inpatient/DRG auditing experience in a hospital setting and/or payer setting</li>
<li>A minimum of 2 years of supervisory experience dealing with clinical auditors is required</li>
<li>Experience with claims denials and appeals required</li></ul> 


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: $77,960 &ndash; $120,368

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. 


ABOUT CERIS:

CERIS, a division of CorVel Corporation, a certified Great Place to Work&reg; Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We 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-Remote</div>

Clinical Review Supervisor

<div>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 &amp; RESPONSIBILITIES:
<ul>
<li>Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager</li>
<li>Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans</li>
<li>Appropriately document work and final conclusions in designated computer program</li>
<li>Additional duties as assigned</li></ul> 


KNOWLEDGE &amp; SKILLS:
<ul>
<li>Thorough knowledge of ICD Diagnoses and Procedure Codes, and C.P.T., as well as an understanding of medical terminology</li>
<li>Knowledge of applicable fee schedule and or applicable U&amp;C Guidelines</li>
<li>Proficient in Microsoft Office applications
</li><li>Technical aptitude with the ability to expand knowledge of MedCheck&rsquo;s proprietary systems</li>
<li>Ability to work independently, follow process guidelines, and meet productivity standards and timelines (must maintain a score of 98% or higher on performance audits)</li></ul> 


EDUCATION &amp; EXPERIENCE:
<ul>
<li>Associate&rsquo;s degree or equivalent experience</li>
<li>CPC or CPC-A required</li>
<li>Previous experience in the following areas preferred:
<ul><li>Medical bill auditing</li>
<li>Knowledge of workers' compensation claims process</li>
<li>Prospective, concurrent and retrospective utilization review</li></ul></li> 
</ul>
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: $22.17 - $35.66 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. 


ABOUT CORVEL:

CorVel, a certified Great Place to Work&reg; Company, is a national provider of industry-leading risk management solutions for the workers&rsquo; 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</div>

(Certified Professional Medical Coder) Professional Review Specialist II

<div>The Senior Liability Claims Specialist manages mid to complex Auto and/or General Liability claims, including bodily injury and property damage. This role aims to achieve optimal outcomes for both CorVel and our clients. The Senior Liability Claims Specialist handles litigated files and works with delegated authority, adhering to company best practices.

This is a remote position.

ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:
<ul>
<li>Receives claims, confirms policy coverage and acknowledgment of the claim</li>
<li>Determines validity and compensability of the claim</li>
<li>Investigates claims and handles Auto and/or General Liability claims</li>
<li>Establishes reserves and authorizes payments within reserving authority limits</li>
<li>Communicates claim status with the customer, claimant, and client</li>
<li>Adheres to client and carrier guidelines and participates in claims review as needed</li>
<li>Collaborates with team members on more complex or problematic claims as necessary</li>
<li>Additional duties as assigned</li></ul> 


KNOWLEDGE &amp; SKILLS:
<ul>
<li>Excellent written and verbal communication skills</li>
<li>Ability to learn rapidly to develop knowledge and understanding of claims practice</li>
<li>Ability to identify, analyze and solve problems</li>
<li>Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets</li>
<li>Strong interpersonal, time management, and organizational skills</li>
<li>Ability to meet or exceed performance expectations</li>
<li>Ability to work both independently and within a team environment</li></ul> 


EDUCATION &amp; EXPERIENCE:
<ul>
<li>Five (5) or more years&rsquo; experience handling General Liability claims, including high exposure and/or litigated claims</li>
<li>Two (2) or more years' experience handling Auto Liability claims</li>
<li>Bachelor's degree or a combination of education and related experience</li>
<li>Current Adjuster&rsquo;s License in state of operation is required</li>
<li>Multi-State license is preferred</li>
<li>Municipality experience is a plus</li></ul> 


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: $29.35 - $47.28 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. 


ABOUT CORVEL:

CorVel, a certified Great Place to Work&reg; Company, is a national provider of industry-leading risk management solutions for the workers&rsquo; 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-Remote</div>

CA Senior Liability Claims Specialist

<div>The WC Senior Claims Specialist handles complex and high-profile Workers' Compensation claims following company standards. This role works closely with case managers and attorneys, manages subrogation, and negotiates settlements. The Senior Claims Specialist ensures the best possible outcome for the claim, meeting customer service expectations, and supporting the goals of the Claims Department and CorVel.

This is a remote position.

ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:
<ul>
<li>Receives Workers&rsquo; Compensation claim, confirms policy coverage and acknowledgement of the claim</li>
<li>Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies</li>
<li>Establishes reserves and authorizes payments within reserving authority limits</li>
<li>Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim</li>
<li>Coordinates early return-to-work efforts with the appropriate parties</li>
<li>Manages subrogation and litigation of claim as it applies</li>
<li>Manages potential claim recoveries of all types</li>
<li>Reports claims to the excess carrier when applicable</li>
<li>Communicates claim status with the customer and claimant</li>
<li>Adheres to client and carrier guidelines and participates in claims review as needed</li>
<li>Develops and maintains professional customer relationships</li>
<li>Complies with rules and regulations of applicable state</li>
<li>Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (&ldquo;IIPP&rdquo;)</li>
<li>Additional duties as assigned</li></ul> 


KNOWLEDGE &amp; SKILLS:
<ul>
<li>Excellent written and verbal communication skills</li>
<li>Ability to assist team members to develop knowledge and understanding of claims practice</li>
<li>Ability to identify, analyze and solve problems</li>
<li>Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets</li>
<li>Strong interpersonal, time management and organizational skills</li>
<li>Ability to work both independently and within a team environment</li>
<li>Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers&rsquo; Compensation</li></ul> 


EDUCATION &amp; EXPERIENCE:
<ul>
<li>Bachelor's degree or a combination of education and related experience</li>
<li>Minimum of 3 years&rsquo; industry experience and claim handling</li>
<li>Self-Insured Certificate preferred</li>
<li>State Certification or license as an experienced claims adjuster</li>
<li>Current license or certification in Workers&rsquo; Compensation must be maintained throughout employment with CorVel</li></ul> 


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: $29.35 - $47.28 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. 


ABOUT CORVEL:

CorVel, a certified Great Place to Work&reg; Company, is a national provider of industry-leading risk management solutions for the workers&rsquo; 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-Remote</div>

CA Senior WC Claims Specialist

<div>The Senior Liability Claims Specialist manages mid to complex Auto and/or General Liability claims, including bodily injury and property damage. This role aims to achieve optimal outcomes for both CorVel and our clients. The Senior Liability Claims Specialist handles litigated files and works with delegated authority, adhering to company best practices.

This is a remote position. This role is open to candidates outside of California.

ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:
<ul>
<li>Receives claims, confirms policy coverage and acknowledgment of the claim</li>
<li>Determines validity and compensability of the claim</li>
<li>Investigates claims and handles Auto and/or General Liability claims</li>
<li>Establishes reserves and authorizes payments within reserving authority limits</li>
<li>Communicates claim status with the customer, claimant, and client</li>
<li>Adheres to client and carrier guidelines and participates in claims review as needed</li>
<li>Collaborates with team members on more complex or problematic claims as necessary</li>
<li>Additional duties as assigned</li></ul> 


KNOWLEDGE &amp; SKILLS:
<ul>
<li>Excellent written and verbal communication skills</li>
<li>Ability to learn rapidly to develop knowledge and understanding of claims practice</li>
<li>Ability to identify, analyze and solve problems</li>
<li>Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets</li>
<li>Strong interpersonal, time management, and organizational skills</li>
<li>Ability to meet or exceed performance expectations</li>
<li>Ability to work both independently and within a team environment</li></ul> 


EDUCATION &amp; EXPERIENCE:
<ul>
<li>Five (5) or more years&rsquo; experience handling General Liability claims, including high exposure and/or litigated claims</li>
<li>Two (2) or more years' experience handling Auto Liability claims</li>
<li>Bachelor's degree or a combination of education and related experience</li>
<li>Current Adjuster&rsquo;s License in state of operation is required</li>
<li>Multi-State license is preferred</li>
<li>Municipality experience is a plus</li></ul> 


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: $29.35 - $47.28 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. 


ABOUT CORVEL:

CorVel, a certified Great Place to Work&reg; Company, is a national provider of industry-leading risk management solutions for the workers&rsquo; 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-Remote</div>

CA Senior Claims Specialist

Join CorVel Corporation and explore 9   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

CorVel Corporation

About Company

Clinical Review Supervisor

(Certified Professional Medical Coder) Professional Review Specialist II

CA Senior Liability Claims Specialist

CA Senior WC Claims Specialist

CA Senior Liability Claims Specialist

CA Senior Claims Specialist

CA Senior Claims Specialist