DUTIES AND RESPONSIBILITIES:
Ability to solve the most complex customer complaints, or inquiries, including bill review disputes verbally and in written communication.
Ability to coordinate and perform independent, comprehensive research of best practices and state options and synthesizes research into clear and concise internal documents.
Ability to review detailed provider appeals and provide both verbal and written communication that includes industry regulations along with applicable client policies.
Maintain an awareness of current laws, statutes, regulations, etc. that impact healthcare operations, and assist in design strategies for implementation activities within the organization.
Research and assist in executing programs addressing healthcare payer policy changes and/or other topics identified as potential risk areas.
Responsible for ensuring new employees are oriented to the organization, its policies, facilities, etc. Supervisors should also provide ongoing guidance to employees, often in the forms of ongoing career coaching, counseling and performance appraisal.
Develops and maintains strong collaborative relationships with internal departments and external clients to maintain excellent lines of communication and share resources to meet business objectives.
Builds customer relationships, interprets customer needs and assesses their business requirements. Also leverages customer knowledge to develop alternative solutions and improve internal processes.
Assists with special projects as assigned by leaders such as interim or stretch roles for personal growth opportunities, collaboration, and providing support to other departments as needed.
5+ years of relevant experience in a medical or insurance field, which required heavy involvement in bill review processing of claims.
1+ years of previous supervisory/management or project management experience a plus.
Proven strong leadership skills as a performer/leader
Knowledge of Medicare (CMS) and Medicaid regulations, regulatory compliance, Managed Care, and medical claims processing guidelines.
Bachelor's degree or higher preferred
MS Word, Excel and Outlook experience, which extends beyond just their basic functionality. (i.e. pivot tables, conditional formatting, advanced formulas).
We are an Equal Opportunity Employer. All persons shall have the opportunity to be considered for employment without regard to their race, color, age, sex, gender, religion, national origin, ancestry, citizenship status, physical or mental disability, military service, veteran status or any other characteristic protected by applicable federal, state or local law.
We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this application or to participate in an interview, please let us know.
Note to Employment Agencies: Please do not forward agency resumes. CorVel Corporation is not responsible for any fees related to unsolicited resumes.
Please be aware that CorVel generally does not review all applications/resumes submitted in response to job openings posted on the Internet because of the large volume of responses