11 bill review analyst i jobs found in Folsom, CA

The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts May consult reference materials in the auditing process Based upon situation or state-specific cases, meet 98% accuracy, 10,000+ keystrokes per hour Additional duties as assigned   KNOWLEDGE & SKILLS: Knowledge of medical terminology, workers’ compensation billing guidelines and fee schedules Knowledge of CPT/ICD/HCPS coding Knowledge of UBO4/DWC-9/DWC-10 and CMS 1500 form types preferred Strong interpersonal skills and commitment to customer service Ability to work independently and in a team environment Ability to identify problems...

The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts May consult reference materials in the auditing process Based upon situation or state-specific cases, meet 98% accuracy, 10,000+ keystrokes per hour Additional duties as assigned   KNOWLEDGE & SKILLS: Knowledge of medical terminology, workers’ compensation billing guidelines and fee schedules Knowledge of CPT/ICD/HCPS coding Knowledge of UBO4/DWC-9/DWC-10 and CMS 1500 form types preferred Strong interpersonal skills and commitment to customer service Ability to work independently and in a team environment Ability to identify problems and find effective...

The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts May consult reference materials in the auditing process Based upon situation or state-specific cases, meet 98% accuracy, 10,000+ keystrokes per hour Additional duties as assigned     KNOWLEDGE & SKILLS: Knowledge of medical terminology, workers’ compensation billing guidelines and fee schedules Knowledge of CPT/ICD/HCPS coding Knowledge of UBO4/DWC-9/DWC-10 and CMS 1500 form types preferred Strong interpersonal skills and commitment to customer service Ability to work independently and in a team environment Ability to identify...

The 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 & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim Coordinates early return-to-work efforts with the...

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 a consistent, timely delivery of our quality services. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate clearly and professionally with providers and other stakeholders via phone and email Understand Workers Compensation guidelines and various client contract language to interpret and support our bill review Navigate the bill review application to obtain accurate information for the callers Understand CorVel EORs as well as client-specific nuances Answer basic to complex State WC fee schedule and/or billing questions...

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 remote position. 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...

The 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 & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim Coordinates early return-to-work efforts with the...

The Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers’ compensation claims under close supervision, supporting the goals of the Claims Department and of CorVel.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgement of the claim Determines the validity and compensability of the claim Establishes reserves and authorizes payments within established reserving authority limits Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Additional duties as assigned   KNOWLEDGE & SKILLS: Excellent customer service skills Excellent written and verbal communication skills Fast learner; develops knowledge and understanding of...

The 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 & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim Coordinates early return-to-work efforts with the...

The Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers’ compensation claims under close supervision, supporting the goals of claims department and of CorVel.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgement of the claim Determines the validity and compensability of the claim Establishes reserves and authorizes payments within established reserving authority limits Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or problematic claims as necessary Additional projects and duties as assigned KNOWLEDGE & SKILLS: Excellent Customer Service Skills Excellent written and verbal communication skills Ability to learn rapidly to develop knowledge and...

Description Are you looking for an opportunity to join a fast-growing company that consistently outpaces the industry in year-over-year growth? Liberty Mutual offers an exciting opening for a Workers Compensation Claims Specialist within the West Region!   As a Workers Compensation Claims Specialist, you will work within a Claims Team, using the latest technology to review, analyze, and process claims that are routinely characterized as moderately complex to complex within assigned authority limits. This includes making decisions about liability/compensability, evaluating losses, negotiating settlements, and managing an inventory of commercial property/casualty claims involving bodily injury or property loss. You may also assist the Claims Team Manager with assigning new claims to team members, providing technical direction, and monitoring caseloads.   Depending on your overall skills and experience, you may be considered as a Claims Specialist II,...