medical review specialist

CorVel Corporation

<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

Godwin Solutions

Entry Level Medical Sales Specialist | Client Services- West Palm Beach, FL 33409 - Godwin SolutionsGodwin Solutions is currently hiring for a full-time Entry Level Medical Sales Specialist to support client acquisition and account management efforts in our West Palm Beach office.This position is designed for individuals entering the field who are seeking a structured role in medical and health-related sales with defined responsibilities and ongoing training.Position SummaryThe Entry Level Medical Sales Specialist works directly with clients to review service options, provide information, and support the development of new and existing accounts. This role combines sales responsibilities with customer support in a team-based office environment.Key Responsibilities<ul><li>Assist clients with understanding and selecting appropriate medical and health insurance - related solutions</li><li>Support the onboarding of new client accounts</li><li>Maintain communication with existing clients to ensure satisfaction</li><li>Accurately document client interactions and updates</li><li>Follow established processes and guidelines for client management</li></ul>Qualifications<ul><li>Strong communication and interpersonal skills</li><li>Ability to learn and apply new information in a structured environment</li><li>Organized and detail-oriented</li><li>Professional and reliable</li><li>Full-time availability for an in-office position</li></ul>No prior license is required to be hired for this role.Training &amp; Development<ul><li>Structured onboarding and training program</li><li>Ongoing support from team leadership</li><li>Development in sales, client communication, and account management</li></ul>Work EnvironmentThis is an in-office position based in West Palm Beach. The role requires consistent attendance, professionalism, and the ability to work within a team-focused setting.Apply NowPlease submit your application and allow 24&ndash;48 hours for our team to review your information. Qualified candidates will be contacted directly regarding next steps.Pay: $108,978.00 - $123,879.00 per yearBenefits:<ul><li>Health insurance</li></ul>Work Location: In person

Entry Level Medical Sales Specialist | Client Services

Beacon Health System

<div><div><div><div><div><div>Beacon Health System is hiring a full-time day Patient Access Insurance Specialist, in our Verification of Benefits Department at Beacon Health System in South Bend, IN. 
 
Be a Beacon. Make a Difference.
At Beacon Health System, you&rsquo;re not just part of a team, you&rsquo;re part of something bigger. Every patient interaction is a chance to lead with compassion, build trust, and create lasting impact. Here, your expertise supports healing, and your heart connects us to the communities we serve.
<ul><li>Medical, Dental, &amp; Vision Insurance through Cigna</li>
</ul><ul><li>Life Insurance</li>
</ul><ul><li>403(b) Matching Retirement Fund</li>
</ul><ul><li>Competitive Paid Time Off (PTO)</li>
</ul><ul><li>Shift Differentials</li>
</ul><ul><li>Employee Assistance Program (EAP)</li>
</ul><ul><li>Tuition and Certification Reimbursement</li>
</ul><ul><li>Clinical Ladder Program</li>
</ul><ul><li>Local and National Discounts</li>
</ul><ul><li>Beacon Academy Educational Courses</li>
</ul><ul><li>Gym Membership Discount</li>
</ul>
About Beacon Health System
Headquartered in South Bend, Indiana, as a not-for-profit, community-governed health system, Beacon Health System provides care to more than 4,000 patients each day in northern Indiana and southern Michigan.
What You&rsquo;ll Do
As a Patient Access Insurance Specialist, you will report to the Patient Access Director or the Insurance Specialist Supervisor. Follows established Beacon policies and procedures to verify insurance coverage to ensure necessary procedures and hospitalizations are covered by an individual's provider. The Insurance Verification Authorization Specialist will assure authorization is obtained for all procedures and diagnostic testing to services being rendered. The Authorization Specialist will also initiate the authorization for direct admissions, emergency admissions, and emergency procedures. They will work closely with medical staff, clinical staff, referring clinics, Beacon Outpatient Scheduling Surgery Scheduling, Social Services, and Utilization Review departments. They will be responsible for communication with insurance carriers and/or providers for purposes of obtaining approval for services requiring authorization, pre-certification, and prior approval for admissions to Beacon or Epworth Center by using web-based tools, other electronic means where possible, or by telephoning and faxing when necessary. Coordinating those visits with the correct paperwork and insurance verification, along with accurate documentation in the patient's medical record is essential. They will answer high volume of incoming phone calls as well as making high volume of outbound phone calls, with constant communication to the Utilization Review, Social Services, Beacon Outpatient Scheduling and Surgery Scheduling departments. Performs other clerical duties as necessary.
Patient Access Insurance Specialist Job Responsibilities:
<ul><li>Verify and update patient demographic and financial information to ensure accuracy in the registration system.</li>
<li>Obtain and validate insurance coverage using online eligibility systems, payer portals, and telephone verification.</li>
<li>Utilize Cerner systems and reports (e.g., PHS, SurgiNet, Medical Necessity Checker) to review scheduled patients, procedures, and medical necessity requirements.</li>
<li>Audit and complete required documentation, including MSP questionnaires and insurance verification records.</li>
<li>Coordinate verification of benefits (VOB) by confirming co-pays, deductibles, coinsurance, out-of-pocket limits, and rehabilitation benefits with insurance providers.</li>
<li>Secure and document pre-authorizations and pre-certifications for ancillary, surgical, outpatient, and inpatient procedures.</li>
<li>Collaborate with physician offices, scheduling teams, and referring facilities to ensure required authorizations are obtained and procedures are properly scheduled.</li>
<li>Validate CPT and ICD-10 codes and confirm compliance with Medicare Inpatient Only Procedure (MIPO) requirements when applicable.</li>
<li>Identify out-of-network insurance plans and follow established policies and procedures.</li>
<li>Refer patients to Financial Counselors or Eligibility Specialists when financial clearance or payment arrangements are required.</li>
<li>Maintain accurate worklists, documentation, and records to support timely claim submission and reimbursement.</li>
<li>Calculate and communicate estimated patient financial responsibility, including co-payments and coinsurance.</li>
<li>Prepare reports, patient statistics, and documentation to support departmental operations and leadership requests.</li>
<li>Provide professional customer service by answering calls, communicating with patients and internal departments, and maintaining positive patient relations.</li>
<li>Collaborate with departments such as Utilization Review, Surgery Scheduling, Social Services, and Outpatient Scheduling to ensure accurate and timely patient processing.</li>
<li>Support departmental quality goals by maintaining productivity, accuracy, and compliance with Beacon policies and procedures.</li>
<li>Maintain professionalism while representing Beacon Health System and perform other duties as assigned.</li>
</ul>
What You Bring
As a Patient Access Insurance Specialist, it requires strong office and computer skills, including keyboarding (minimum 40 wpm), data entry, and proficiency with systems such as Cerner, Pathways Healthcare Scheduling, Experian, and MCA Compliance Checker. Demonstrates knowledge of medical terminology, insurance coverage, managed care networks, ICD-10 and CPT codes, and time-of-service collections, including the ability to clearly communicate financial responsibilities to patients. You will possess strong telephone, verbal communication, and listening skills to effectively interact with patients, insurance companies, physicians, and internal departments. You will maintains professionalism and sensitivity when working with diverse populations, follows strict confidentiality policies, exercises sound judgment in stressful situations, and applies basic math skills to calculate patient financial responsibilities such as deductibles, coinsurance, and out-of-pocket costs.
Required Qualifications
<ul><li>The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a high school diploma (or equivalent).
</li><li>A minimum of two years of experience in a hospital or physician practice business office is required.
</li><li>Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills required.</li>
<li>A medical terminology course must be successfully completed prior to employment.
</li><li>Associate's degree preferred.
</li><li>Medical prior authorizations or claims experience in a managed care setting and CHAA certification are highly preferred.</li>
</ul>
The Beacon Way
At Beacon Health System, our approach to care goes beyond clinical excellence because it&rsquo;s built on meaningful connections. Guided by our core values of Trust, Respect, Integrity, and Compassion, we strive to create an environment where patients feel heard, employees feel valued, and innovation thrives.
We call this commitment The Beacon Way&mdash;a six-point operating system that empowers every team member to lead with purpose, communicate clearly, cultivate talent, embrace performance improvement, leverage innovation, and build greatness through accountability. Whether at the bedside or behind the scenes, everyone at Beacon plays a role in moving health forward.</div> 
</div>
</div></div></div> 
Location: Beacon Health System &middot; Verification of Benefits 
Schedule: Full-time, Day, 0830-5pm M-F</div>

Patient Access Insurance Specialist, Verification of Benefits Department, Full-Time Days

Zeal Integrated Health

Overview We are seeking a detail-oriented and experienced Billing Specialist to join our team. The ideal candidate will have a strong background in medical billing and coding, with proficiency in various coding systems. This role is essential in ensuring accurate billing processes and maintaining compliance with medical regulations. The Billing Specialist will work closely with healthcare providers and insurance companies to facilitate smooth billing operations.Duties<ul><li>Process and manage medical billing for various services rendered by healthcare providers.</li><li>Utilize coding to ensure accurate claim submissions.</li><li>Review patient records for completeness and accuracy before billing.</li><li>Handle medical collections and follow up on outstanding claims or payments.</li><li>Maintain organized medical records and ensure compliance with relevant regulations.</li><li>Collaborate with healthcare staff to resolve billing discrepancies or issues.</li><li>Utilize EMR and EHR systems effectively for documentation and billing purposes.</li><li>Stay updated on changes in medical terminology, coding practices, and insurance policies.</li></ul>Requirements<ul><li>Proven experience in medical billing, coding, or a related field is essential.</li><li>Familiarity with general medical terminology is required.</li><li>Experience with EMR and EHR systems is highly desirable.</li><li>Strong attention to detail and organizational skills are a must.</li><li>Excellent communication skills for interacting with healthcare providers and patients.</li><li>Previous experience in a medical office setting is preferred.</li><li>Ability to work independently as well as part of a team in a fast-paced environment. If you are passionate about ensuring accurate medical billing processes and possess the necessary skills, we encourage you to apply for this rewarding opportunity as a Billing Specialist.</li></ul>Job Type: Full-timePay: $18.00 - $21.00 per hourBenefits:<ul><li>Health insurance</li><li>Paid sick time</li><li>Paid time off</li></ul>Work Location: In person

Billing Specialist

Rehabilitation Equipment Associates

Job SummaryREQ, a family owned Durable Medical Company in Manchester, is looking for a Billing Specialist to join our awesome Billing Team! The Billing Specialist plays a crucial role in the healthcare industry by ensuring accurate and timely billing processes.Candidate will work with insurance companies to ensure proper reimbursement, management and processing of accounts in a timely manner.<ul><li>Responsibilities include pre-authorization of benefits and eligibility, refiling claims, payer and client account follow-ups.</li><li>Review and analyze medical records for proper coding and billing.</li><li>Assign appropriate diagnostic and procedural codes.</li><li>Experience in medical office billing or collections is preferred.</li><li>Strong attention to detail and accuracy in data entry.</li><li>Excellent communication skills to interact with patients, providers, and insurance companies.</li></ul>On-the-job training provided. Candidate may submit resume.<ul><li>We are an Equal Opportunity Employer!</li></ul>Job Type: Full-timeBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Employee discount</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: In person

Billing Representative

The Acadian Companies

<div>Acadian Client Services has an immediate opening for a full-time Vendor Management Billing Specialist to join their team in Lafayette, LA.

Job Location: Lafayette, LA - This position is based in the office, Monday-Friday, 8:00am-5:00pm. This is NOT a Work from Home position.

Summary of Duties: The Vendor Management Billing Specialist is responsible for auditing and increasing the quality standards within the revenue cycle department by reviewing claims processes, billing protocols, and write off protocols are followed according to established policies. This position will independently review claims and make recommendations to senior leadership on process improvements or educational opportunities.

Essential Functions:
<ul>
<li>Responsible for claim status checks as needed to ensure proper resolution</li>
<li>Initiating contact with insurance providers as needed</li>
<li>Review and process claim rejections and appeals for research and resolution</li>
<li>Monitor payment discrepancies and process payments</li>
<li>Review claims for Federal compliance</li>
<li>Process incoming correspondence and phone calls specific to the payer type</li>
<li>Verification of patient insurance</li>
<li>Ensure accuracy of demographic information</li>
<li>Other duties and responsibilities as assigned</li>
</ul>
Qualifications:
<ul>
<li>High school diploma or equivalent</li>
<li>Previous medical billing experience preferred</li>
<li>Proficient in Google, MS Office Suite or related software</li>
<li>Possess strong organizational skills</li>
<li>Punctual with strong attendance history</li>
<li>Ability to adhere to productivity goals, departmental and company guidelines, dress code, policy and procedures</li>
<li>Excellent interpersonal skills and time management</li>
<li>Maintain highest level of confidentiality</li>
</ul>
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. 
 
Req Benefits: We offer comprehensive insurance benefits for full-time employees, including but not limited to Medical, Dental, Vision coverages, along with 401(k) and ESOP (Employee Stock Ownership Program), and Vacation and Sick time.</div>

Billing Specialist (Vendor Management)

SRS Distribution

<div>Supplier Maintenance Specialist
SRS Distribution, Inc. is hiring a Supplier Maintenance Specialist. The person in this role will be responsible for the onboarding and maintenance of supplier records within our supplier database. With the broader AP and Procurement teams, the Specialist will focus on working with requesters and suppliers to set up and maintain information, including supplier names, addresses, banking information, and classification. The Specialist will review and audit requests for accuracy and resolve any data issues. The Specialist will process rebates and act as backup for other Supplier Maintenance Specialists. The Specialist should be comfortable communicating with various stakeholders, including End Users, Procurement, Audit, and management to ensure items are actioned properly and timely. Duties may also include a review of the Supplier onboarding process and policy and providing feedback and testing, when necessary, as well as other Accounts Payable tasks.
Essential Job Functions:<ul><li>
Work with requesters and suppliers to process new supplier set-ups and maintenance requests including requesting and verifying all w-9s for accuracy.</li><li>
Review and audit supplier data and resolve issues.</li><li>
Process documentation for the acquisition team.</li><li>
Assist with ServiceNow tickets for SRS and Heritage.</li><li>
Communicate with internal and external customers/vendors (Purchasing, Legal, Contracting, Accounting) to ensure timely processing of such requests.</li><li>
Ensure that requests follow established policies and procedures and adhere to SOX and other controls.</li><li>
Participate in team and departmental meetings as required.</li><li>
Collect P2P data and communicate it to business users and suppliers as necessary.</li><li>
Perform other duties and projects as assigned.</li></ul>
Requirements:<ul><li>
1- 4 years of relevant work experience in Vendor Maintenance, and/or Accounts Payable.</li><li>
Experience working with large data sets.</li><li>
High capacity for strategic thought and ability to execute initiatives.</li><li>
Excellent written and oral communication and research skills.</li><li>
Excellent attention to detail and ability to work in a fast-paced, high-transactional environment.</li><li>
Advanced proficiency in MS Office products, especially Excel.</li><li>
Advanced knowledge of W-9 and 1099 requirements and tax implications; along with verification through the IRS website preferred.</li><li>
Must be organized &amp; a self-starter.</li><li>
Must be able to work independently and as a team.</li></ul> 
Not the right job for you? Register your details at the 'Introduce Yourself' link (top right) and we'll be in touch! 
Job Location: SRS Distribution - McKinney 
7440 State Highway 121 McKinney, TX 75070-3104
&lrm;
As an Equal Employment Opportunity (EEO) employer SRS Distribution Inc., including all its subsidiaries, provides job opportunities to qualified individuals without regard to actual or perceived race, color, creed, religion, national origin, sex, gender, age, disability, gender identity, sexual orientation, citizenship status, uniform service, veteran status, marital status, genetic information, physical or mental disability, or any other characteristic in accordance with applicable federal, state, and local EEO laws. If you are an individual with a disability or a disabled veteran and require a reasonable accommodation in applying for any posted position, please contact Human Resources at US: 855.556.3221, or by email to: HR@Help.SRSDistribution.com with the nature of your accommodation request and include the Business name, location and title of the job opening. Please allow one (1) business day for a reply. All employment offers are contingent upon successful completion of a background check and drug screen, as permitted by law.
&lrm;
Competitive weekly/bi-weekly pay, discretionary bonuses, 401(k) with company match, Employee Stock Purchase Plan, paid time off (vacation, sick, volunteer, holidays, birthday, floating), medical/dental/vision, flexible spending accounts, company-paid life and short-term disability, plus optional long-term disability, and additional life insurance. All benefits subject to eligibility.
&lrm;
&lrm;
Should a Candidate be submitted to fill a position by a recruiting or staffing services agency (&ldquo;Agency&rdquo;), the Company has no obligation to pay the Agency any fee for submission, offer, placement or any service without a fully executed contract of service covering the engagement.
<h3 class="jobSectionHeader"> 
Benefits</h3>
<div><div><div><div><ul><li>Competitive salaries for all team members paid weekly</li>
<li>401(k) Retirement Plan with company matching</li>
<li>Employee Stock Purchase Program</li>
<li>Paid Vacation, Sick Time, Volunteer Day, Holidays, Birthday, and Floating Holidays</li>
<li>Paid Parental Leave, Adoption Assistance Program</li>
<li>Medical, Dental and Vision Benefits</li>
<li>Flexible and Dependent Care Spending Accounts</li>
<li>Company paid Life insurance and Short-Term Disability</li>
<li>Additional Life Insurance and Long-Term Disability also offered</li>
<li>Mental, Physical and Emotional Well-Being Programs for Employees and Families</li>
<li>Wellness Program and Safety Program with Bonuses for our Drivers</li>
<li>Employee Referral Bonus Program</li></ul></div></div></div></div></div>

Supplier Maintenance Specialist

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