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Revenue Cycle Specialist I
CorVel Corporation
- Fort Worth, Texas, United States
- Fort Worth, Texas, United States
Über
Remote Position The position is remote.
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
With precision identifies errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners
Performs contract and reimbursement variance analysis
Analyzes claims data to identify contractual overpayments and billing errors
Assists department and leadership in obtaining complex information from various financial, clinical and operational systems and data sources
Learns or remains current on billing protocols and regulations, federal and state regulations, and internal procedures that affect processing
Provides subject matter expertise on billing and coding guidelines and regulations as required by the department
Uses internal and external billing protocols and regulations for repricing bills at a cost savings to the customer
Identifies trending opportunities related to policies and procedures to ensure efficiency and accuracy in bill processing
Establishes and maintains detailed knowledge and documentation of all analysis/data sources within the department
Analyzes all forms of Revenue Cycle transactions
Possesses the ability to run standard Revenue Cycle and operations reports to answer questions from department/practice managers, vendors, physicians, and other Revenue Cycle stakeholders
Produces daily, monthly and annual evaluative and statistical reports, analyzing drivers of variances from period to period to ensure the integrity and accuracy of revenue cycle data
Evaluates 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
Ability to work independently and use critical thinking
Detailed knowledge of pay reimbursement methodology for
Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable)
Strong understanding of healthcare revenue cycle and claims reimbursement
MS Office includes Word, PowerPoint, Excel and Outlook, Windows operating system and Internet
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
Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable
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.
Benefits 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.
Equal Opportunity Employer CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
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Sprachkenntnisse
- English
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