The Revenue Cycle Specialist is responsible for analysis and monitoring of claims audit data across multiple platforms. Performs various follow-up activities to ensure the accuracy and appropriateness of reimbursement made to healthcare providers. Responsibilities include identifying payment variances and working internally and externally to resolve such issues.
This is a remote position.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
- Analyze and adjust/reprice claims to ensure accurate reimbursement rates in accordance with contractual agreements and payer guidelines
- Establishing and maintaining accurate pricing structures and rules to ensure competitive and profitable pricing strategies across various claims
- Identify errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners
- Perform contract and reimbursement variance analysis
- Analyze claims data to identify contractual overpayments and billing errors
- Assist department and leadership in obtaining complex information from various financial, clinical and operational systems and data sources
- Learn or remain current on billing protocols and regulations, federal and state regulations, and internal procedures that affect processing
- Provide subject matter expertise on billing and coding guidelines and regulations as required by the department
- Use internal and external billing protocols and regulations for repricing bills at a cost savings to the customer
- Identify trending opportunities related to policies and procedures to ensure efficiency and accuracy in bill processing
- Establish and maintain detailed knowledge and documentation of all analysis/data sources within the department
- Analyze all forms of Revenue Cycle transactions
- Run standard Revenue Cycle and operations reports to answer questions from department/practice managers, vendors, physicians, and other Revenue Cycle stakeholders
- Produce daily, monthly and annual evaluations and statistical reports, analyzing drivers of variances over time to ensure the integrity and accuracy of revenue cycle data
- Evaluate integrity of client data including actively participating with and supporting the Product and Account Management teams with trend analysis of payment and data variances
- Ensure strict confidentiality of all medical records, PHI, and PII
- Additional duties as assigned
KNOWLEDGE & SKILLS:
- Demonstrated knowledge of claims processing, DRG Validation, CMS guidelines, and ICD-10 coding guidelines as applicable
- Detailed knowledge of pay reimbursement methodology
- Strong understanding of healthcare revenue cycle and claims reimbursement
- Knowledge of Microsoft Office products, including Word, PowerPoint, Excel and Outlook, Windows operating system and Internet
- Ability to work independently and use critical thinking
- Strong analytical and problem-solving skills
- Strong attention to detail and ability to deliver results in a fast paced and dynamic environment
EDUCATION & EXPERIENCE:
- Claims repricing, pricing configuration, or provider maintenance experience required
- 3+ years of relevant experience or equivalent combination of educations and work experience
- High School Diploma or equivalent required
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: $19.21 - $28.73 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 CERIS:
CERIS, a division of CorVel Corporation, a certified Great Place to Work® 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.
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Equal Opportunity EmployerThis employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
Skills Required
- Claims repricing, pricing configuration, or provider maintenance experience
- 3+ years of relevant experience or equivalent combination of education and work experience
- High School Diploma or equivalent
- Demonstrated knowledge of claims processing, DRG validation, CMS guidelines, and ICD-10 coding guidelines
- Detailed knowledge of payer reimbursement methodology and healthcare revenue cycle
- Knowledge of Microsoft Office (Word, PowerPoint, Excel, Outlook), Windows operating system, and Internet
- Strong analytical and problem-solving skills, critical thinking, attention to detail, and ability to work independently
- Experience performing contract and reimbursement variance analysis, reconciliations, and producing operational reports
CorVel Corporation Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CorVel Corporation and has not been reviewed or approved by CorVel Corporation.
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Wellbeing & Lifestyle Benefits — Work-from-home options and schedule flexibility are highlighted as meaningful offsets to lower base pay in certain roles. An Employee Assistance Program and related resources further support everyday wellbeing.
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Flexible Benefits — Multiple medical plan choices with dental/vision and a broad suite of supplemental coverages offer choice tailored to role and location needs. An HSA option with a company match adds flexibility in how healthcare expenses are managed.
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Retirement Support — A 401(k) with a company match is part of the core package.
CorVel Corporation Insights
What We Do
CorVel is a leader of risk and healthcare management solutions to employers, third party administrators, insurance companies and government agencies. We are publicly traded and annual revenues exceeded $595 million in FY2019. Our continued customer growth is a testament to our financial stability and our significant investments in new systems and technologies allows us to continue to deliver industry-leading solutions to the marketplace. CorVel has approximately 3,500 associates who serve customers through a national branch office network covering all 50 states.
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