Teams at CorVel Corporation

Lead and perform pre- and post-pay claim audits using client policy, CMS guidelines, and industry standards; oversee QC analysts, conduct internal audits and appeals, develop QA measures, train staff, and research payment policy best practices.

Provide telephonic medical case management for injured or ill individuals: assess needs, develop and implement cost-effective care plans, coordinate with physicians, payers, employers and providers, recommend treatment alternatives, arrange durable medical equipment and nursing services, prepare timely reports, and meet productivity standards.

Review, audit, and data-enter medical bills for multiple states and lines of business to ensure adherence to state fee schedules, customer guidelines, PPO discounts, and coding standards. Meet accuracy and productivity targets and perform related duties as assigned.