Professional Review Supervisor

The Professional Review Supervisor is responsible for performing a professional coding review of medical records and/or other documentation to determine correct Fee Schedule application, the application of all applicable coding rules and be able to provide the resource and background support for review. The Professional Review Supervisor must be skilled in all review methodologies specific to each state for which review services are being provided. This involves completing medical review forms, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the review.

This is a remote position.

Essential Functions & Responsibilities

• Assist Professional Review Manager in any delegated areas
• Receives claim and processes based on state rules and regulations
• Be able to determine validity and compensability of the claim using CorVel proprietary programs
• Be familiar with all states reviewed by Fort Worth Professional Review and perform consistently accurate QC for the team.
• Strong training and leadership knowledge and skills to engage and educate new team members
• Assist in production as inventory dictates
• Make recommendations to referring office when needed
• Communicate claim status with referring office when needed
• Read and comprehend all medical reports
• Adhere to client and carrier guidelines and participate in claims review as needed
• Assists other claims professionals with more complex or problematic claims as necessary
• Additional duties/responsibilities as assigned
• Comply with all safety rules/regulations, in conjunction with the Injury and Illness Prevention Program (“IIPP”), as well as, maintain HIPAA compliance
  
  

Knowledge & Skills

• Ability to learn rapidly to develop knowledge and understanding of claims practice
• Strong organizational skills
• Ability to meet or exceed performance competencies
• Effective and professional communication skills
• Ability to handle stressful situations, and use critical and strategic thinking
• Demonstrated outstanding leadership, problem solving, and analytical skills
• Ability to think and work independently, while working in an overall team environment
• Proficient in Microsoft Office Suite, especially Excel and Outlook

Education & Experience

• High School diploma, or equivalent
• Current AAPC certification (which must be maintained throughout employment as current and active status)
• Certification as CPC with the AAPC for more than 2 years (w/ surgical or office experience)
• Current or recent orthopedic billing/coding experience
• E/M coding/down-coding experience
• EncoderPro software experience
• Texas workers compensation experience is preferred
• Pain Management/Anesthesia/General Surgery coding experience is preferred
  
  

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: $52,808 – $79,029

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

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.