2 customer service representative ii jobs found in Folsom, CA

The Provider Relations Specialist assists providers via phone and email with bill review questions and requests of varying complexity. This role is responsible for documenting bill review errors to improve team error rate trend. The Provider Relations Specialist acts as a positive and professional representative of our CorVel family. The role ensures compliance with company best practice standards while also enabling consistent, timely delivery of our quality services. This role may be transitioned into a Knowledge Center Representative role within the first year of employment, based on business needs. While both the Provider Relations Specialist and the Knowledge Center Representative roles are customer support roles with overlapping core functions, specific responsibilities pertaining to only the Knowledge Center Rep role are marked as such in the below job description. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate clearly and...

The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.   This is a remote position in CA. 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 Utilize clinical and/or technical expertise to address the provision of medical care and identify inappropriate billing practices and errors, such as: duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time...