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Job Description The Hospital Bill Audit Nurse conducts hospital bill charge audits by reviewing medical records to verify that services were provided and charges are appropriate based on medical documentation and industry guidelines. The types of audits performed could include, but are not limited to inpatient, outpatient, NICU, and hospice. Charge audits identify overcharges, undercharges, and unbundled items per payor contract and industry standards. This role is responsible for independent scheduling requiring flexibility and travel to provider location. This is a remote position with travel required. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: • Acknowledge assigned work, maintain timely communication with Audit Coordinator, schedule and complete audits in an efficient and timely manner, • Travel onsite as needed to perform audits, • Review medical records to verify services were provided and charges are accurate – identify overcharges/undercharges, unbundled items, errors, duplicates, routine services, and equipment/supplies, • Identify discrepancies if they exist and document the findings using standard documentation guidelines applicable to the position, • Understand audit and data information to make decisions with accurate results, • Document all unsupported charges identified during an audit, • Report any problems in the auditing process to the manager and/or supervisor for resolution, • Comply with all HIPAA and other regulations regarding the confidentiality of patient information, • Comply with all provider and internal policies and guidelines, • Must represent CorVel/CERIS in a professional and knowledgeable manner, • Additional duties as assigned KNOWLEDGE & SKILLS: • Knowledge and understanding of hospital billing/charging including UB-04’s, itemized bills, revenue codes, CPT/HCPCS codes, ICD10 diagnosis and procedure codes, • Strong working knowledge of CMS, payor, and other industry guidelines preferred, • Excellent written and verbal communication skills necessary to interact positively with both external and internal customers, • Computer skills necessary to manage correspondence, information entry and retrieval from system, and the ability to create and participate in virtual meetings, • Reasonable proficiency in Microsoft Office applications including Excel, • Exceptional attention to detail, • Must have advanced organizational, strategic, and critical thinking skills, • Ability to handle stressful situations and adapt accordingly, • Ability to work in a fast-paced environment, • Ability to work independently EDUCATION & EXPERIENCE: • Associate Degree in Nursing or higher required, • Must maintain current licensure as a Registered Nurse in the state of employment, • Previous external or internal medical bill audit experience highly preferred, • Minimum of 5 years’ experience in the OR, ICU, or ER as an RN highly preferred, • Hospice experience a plus 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: $62,306 – $93,123 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. #LI-Remote

Job Description The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care. Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: • Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager, • Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans, • Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) and other requirements as outlined in the Employee Handbook, • Must be able to communicate concisely and effectively in writing and verbally, • Must have the ability to interface with the claims adjusters, attorneys, physicians and their representatives, and advisors/clients, and co-workers, • Must have the ability to effectively promote all Professional Review products with attorneys, claims examiners, customers and management, • Must also have a strong ability to negotiate provider fees effectively, • Must be computer literate, • Knowledge of worker's compensation claims preferred EDUCATION & EXPERIENCE: • Must maintain current licensure as a Registered Nurse in the state of employment with a minimum of 4 years clinical experience, • A minimum of an Associate Degree in Nursing as well as have a thorough knowledge of both C.P.T. and I.C.D.10 codes is preferred, • Medical bill auditing experience preferred, • Experience in the clinical areas of O.R., I.C.U., C.C.U., E.R., and orthopedics preferred, • Prospective, concurrent and retrospective utilization review experience 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: $47,061 – $70,236 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. #LI-Remote

Job DescriptionThe Account Manager (AM) at GuideStar Eldercare (GSE) has a primary role of vertical sales (Heads in Beds initiative) within GSE's existing, contracted long term care facilities. The AM additionally manages the implementation of GSE services with newly contracted facilities and addresses any issues concerns and questions facilities may have regarding GSE services. A customer service-oriented position, the AM will build relationships with existing customers while performing audits, educating facility staff, scheduling clinical visits, and assisting with marketing outreach and presentation to facilities when requested.Job Functions & Responsibilities: • The AM agrees to work as reasonably scheduled by Company., • Primary function of this role is to meet vertical sales goals established within the Heads in Beds (HIB) initiative. Autonomous field sales (growing referrals), independent decision-making, and building relationships with clients., • Must have reliable transportation between home and all assigned facilities in sales region., • Manages the implementation of GSE services with facility sites., • Provide education to facility staff regarding the referral process as well as informational materials., • Support clinician-facility interactions and serve as liaison; introduce providers to key facility personnel and expediate the onboarding (including facility walk-thru) and support of clinical providers with administrative issues encountered in facilities (passwords, EMR access, etc.)., • Develop client service improvement strategies in conjunction with GSE regional, clinical, marketing, and operations management/teams. Lead the implementation of such strategies., • Serve as primary GSE contact with facility staff. Maintain up-to-date records of facility contacts. Perform soft surveys of customer satisfaction. Track and trend client issues to identify patterns that require process improvement., • Services provided by the AM shall be performed almost exclusively at independent and distinct facilities (i.e. nursing homes and assisted living facilities). Travel by car may be required daily, of which overnight stays may be approximately 5-10%., • Meet established monthly vertical sales goals for Heads in Beds initiative., • Performs audits to identify patients within facilities who are eligible for GSE services. Consult with long term care facility staff to strategize and implement a referral plan., • Maintain and grow relationships with staff at client facilities.Benefits of Working Here:, • Employee's medical premiums are 100% company paid, • $50,000 in basic life and AD&D insurance coverage is provided, • GuideStar 401(k) plan, • 3 weeks (15 days) paid time off plus 7 paid holidaysQualifications:, • High School diploma or GED equivalent required. Bachelor’s degree in Social Science/Social Work preferred., • 1-3 years of proven successful field sales experience OR 1-3 years of experience in an administrative role at a long-term care facility., • Proven ability to work autonomously with little direct supervision., • Excellent proficiency in customers service and sales., • Organized and resourceful. Excellent time management skills. Ability to multi-task., • Available for remote work or facility events some evenings and weekends., • Proficiency with MS Office suite of products, especially Word, Excel, and PowerPoint., • Abel to effectively and professionally communicate with individuals at all levels of GSE or client organizations., • Able to pass background testing, including motor vehicle record review and drug screening., • Valid driver’s license, • Active auto insurance policy, • Must be able to drive an average of two to four (2-4) hours daily between home and all assigned work facilities. Ability to drive in the dark is required. Must be able to transition between stationary positions and moving about facilities. May occasionally need to position self to reach items under or behind desks. Opens and closes doors. Often operates a laptop. Occasionally climbs stairs. Occasionally moves or transports supplies weighing up to 10 lbs. We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

Job Description The Policy and Payment Integrity Manager oversees the PPI team and assists with implementation of policies to perform reviews conducted by CERIS, including but not limited to itemized bill review, professional review, hospital outpatient and DRG validation. This role manages members of the PPI team, developing team strengths and improving weaknesses, identifying team goals, and evaluating team progress. The Policy and Payment Integrity Manager provides trend analysis of internal auditing of claims for accuracy related to pre- and post-payment claims, targeted claims, high dollar claims, and any other claim or record that requires quality review. The role assists with development of internal quality assurance measures based on client policy and industry guidelines. The manager also aids in researching and implementing best practices related to (CMS) payment policies, healthcare policies, client, state, and/or policy initiatives. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: • Assists with development and modification of standard operating procedures for PPI team, • Utilizes healthcare and auditing experience to design, develop and implement audit criteria that are relevant and necessary for the continuous development services performed by CERIS, • Exercises good judgment to resolve complex claim and appeal issues and makes sound decisions in the absence of detailed instructions or during escalations, • Participates in discussions with internal and external stakeholders in regards to reviews conducted by CERIS, including but not limited to itemized bill review, professional review, hospital outpatient and DRG validation, • Researches, interprets, communicates, and applies CMS, Federal, State and client policies to claims review, • Works with operational leaders within the business to recommend opportunities for process improvements, • Acts as a resource and liaison for internal departments, account management, senior management and clients, as needed, • Additional duties as assigned KNOWLEDGE & SKILLS: • Strong interpersonal skills and adaptive communication style, complex problem solving skills, drive for innovation and results, • Ability to manage multiple projects, set priorities and adhere to predetermined schedule, • Strong knowledge of itemized bill review, ASC, and outpatient claim review, • Understanding of CMS and commercial payer policy, • Strong understanding of claims processing, ICD-10 Coding, DRG Validation, and Coordination of Benefits, • Strong understanding of healthcare revenue cycle and claims reimbursement, • Proficient in Microsoft Office, including Pivot Tables and Database Management, • Comfortable interfacing with clients and the C-Suite, • Excellent written and verbal communication skills, • Proven track record of delivering concrete results in strategic projects/programs, • Strong analytical skills and data-driven decision-making, • Superb attention to detail and ability to deliver results in a fast paced and dynamic environment EDUCATION & EXPERIENCE: • Must maintain a current RN licensure in the state of employment, • Must maintain a current coding license (CPC, CCS, RHIT, etc.), • 3+ years of management experience, • Minimum of 5 years’ experience in Operating Room, either as a circulating RN or scrub RN, as well as 2 years’ clinical experience in an acute care facility, • Knowledge of worker's compensation claims process, • Prospective, concurrent and retrospective utilization review, • 5+ years of relevant experience or equivalent combination of education and work experience, • 3+ years hospital bill audit, • Bachelor’s degree in healthcare or related field, • Previous experience in the following areas preferred:, • Medical bill coding and auditing, • DRG and Clinical Validation, • Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics 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: $80,718 – $124,624 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. #LI-Remote