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JOB DESCRIPTION Looking for a RN that has a current active unrestricted license This a remote role and can sit anywhere within the United States. Work Schedule Monday to Friday - operation hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers. Job Duties • Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing., • Identifies and reports quality of care issues., • Assists with Complex Claim review including DRG Validation, Itemized Bill Review, Appropriate Level of Care, Inpatient Readmission, and any opportunity identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience, • Documents clinical review summaries, bill audit findings and audit details in the database, • Provides supporting documentation for denial and modification of payment decisions, • Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care., • Reviews medically appropriate clinical guidelines and other appropriate criteria with Medical Directors on denial decisions., • Supplies criteria supporting all recommendations for denial or modification of payment decisions., • Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals., • Provides training and support to clinical peers., • Identifies and refers members with special needs to the appropriate Molina Healthcare program per policy/protocol. JOB QUALIFICATIONS Graduate from an Accredited School of Nursing REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: • Minimum 3 years clinical nursing experience., • Minimum one year Utilization Review and/or Medical Claims Review., • Minimum two years of experience in Claims Auditing, Medical Necessity Review and Coding experience Active, unrestricted State Registered Nursing (RN) license in good standing. PREFERRED EDUCATION: Bachelors’s Degree in Nursing or Health Related Field PREFERRED EXPERIENCE: Nursing experience in Critical Care, Emergency Medicine, Medical Surgical, or Pediatrics. Advanced Practice Nursing. Billing and coding experience. PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional in Healthcare Quality or other healthcare certification. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $26.41 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Description The Clinical Review Manager is responsible for the overall aspects of the Clinical Review Department including personnel hiring, quality assurance of product, workflow, maintaining the tracking of and accountability of staff regarding production standards and turn-around expectations. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: • Responsible for managing the daily file flow coming into Clinical Review while maintaining awareness of potential file flow from other departments to track rush or special files, test files, pilot studies for prospective clients, • Writing performance evaluations for direct report staff on annual basis in accordance with company best practices, • Keeping Department error ratio to less than 2% minimum on all approved files checked per month, • Responsible for human resources matters directly related to department staff under direct supervision including documentation of events or occurrences and verbal counseling direct report staff when attendance or performance deficiencies are discovered, • Train, Assist and Direct Supervisors as needed, • Requires regular and consistent attendance and the tracking of attendance of staff under direct supervision, in addition to ensuring adequate staffing levels during holiday seasons and peak times, • Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP), • Responsible for implementing new procedures/protocols as necessary, • Responsible for maintaining and updating department protocol library, • Assist EBR Manager with their duties, when requested, with a positive attitude, • Participate in provider calls and meetings for designated clientele, • May be required to travel overnight and attend meetings or training of various nurses in EBR Medical Review, • May perform daily, weekly, monthly reviews of various reports, invoices, logs and expenses, • Additional duties as assigned KNOWLEDGE & SKILLS: • Proficient in Medicare, CMS guidelines and ICD-10 coding guidelines, • Extreme attention to detail, • Must possess problem solving, critical thinking skills, • Minimal typing experience, • Effective and professional communication skills, both verbal and written, • Ability to think and work independently, while working in an overall team environment, • Ability to work in a fast paced/production environment, • Proficient in Microsoft Office Suite EDUCATION & EXPERIENCE: • Minimum of 3-5 years of inpatient/DRG coding experience in a group health payment integrity setting or 3 party audit company, • A minimum of 2 years of supervisory experience dealing with clinical auditors is required, • Must be an R.N./L.V.N. licensed in the State of Texas, • CPC or CPMA preferred with DRG coding experience in ICD-10, ICD-10 PCS, CPT and HCPC 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: $81,617 – $135,877 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 Diagnostic Related Groups (DRG) Clinical Audit Supervisor is responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the contract 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 determination. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: • Supervises all daily activities of the DRG Clinical Auditors, • Demonstrated knowledge of, ICD-10-CM and PCS codes, and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid with the ability to work independently with minimal supervision and demonstrate initiative, • Required to complete DRG audits as needed, • Responsible for the overall integrity of the quality of diagnosis and procedure codes verified by the clinical review nurses, for inpatient records and documentation received with the accompanied claim, • The ideal Clinical Audit Supervisor candidate will have strong oral and written communication skills, clinical knowledge of disease process, and knowledge of medical necessity rules, • Experience with claims denials and appeals, • Responsible for holding the DRG Clinical Auditors to the quota and error/accuracy rate, • Working knowledge of HIPAA Privacy and Security Rules, • Ability to multi-task. Assist with team coverage and provide support when needed, • Ability to build relationships both internally and externally, • Demonstrated proficiency in basic computer skills and typing, i.e., Microsoft Windows, Outlook, Word, PowerPoint, Internet Explorer, etc. KNOWLEDGE & SKILLS: • Extreme attention to detail, • Must possess problem solving, critical thinking skills, • Minimal typing experience, • Effective and professional communication skills, both verbal and written, • Ability to think and work independently, while working in an overall team environment, • Ability to work in a fast paced/production environment, • Proficient in Microsoft Office Suite EDUCATION & EXPERIENCE: • N./L.V.N. preferred, • CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS, • Proficient in Medicare, CMS guidelines and ICD-10 coding guidelines, • Minimum of 3-5 years of inpatient/DRG auditing experience in a hospital setting and/or payer setting, • A minimum of 2 years of supervisory experience dealing with clinical auditors is 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: $76,207 – $117,662 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 DescriptionAre you passionate about making a difference in patients' lives through compassionate care and technical expertise? We are seeking a dedicated and skilled Allied Healthcare Professional's to join our dynamic healthcare team. If you're driven by a commitment to patient well-being and are ready to work in a fast-paced, rewarding environment, we invite you to apply and become a valued member of our healthcare team Position: Technicians and Technologist needed Various Schedules: AM & PM Shifts What You'll Do: In this role, you will provide essential support in patient diagnosis, treatment, and rehabilitation, collaborating closely with physicians, nurses, and other healthcare professionals. Whether you specialize in diagnostic imaging, laboratory work, rehabilitation, or patient care, your contributions will play a crucial role in delivering exceptional healthcare services. Each specialty within allied health requires different certifications and specific technical skills but overall focuses on supporting medical teams in diagnosis, treatment, rehabilitation, or administrative tasks. Why Join Us: • Professional Growth: Expand your nursing proficiency and knowledge while experiencing a range of cases and scenarios that enrich your career journey., • Adventurous Opportunities: As a Travel Registered Nurse, you will have the chance to explore diverse locations across the United States. Expand your professional horizons while enjoying the adventure of new environments. Assisting in diagnosis: * • Operating equipment like X-rays, MRIs, or ultrasound machines (radiology technicians, sonographers)., • Laboratory work: Performing blood tests, urine tests, or other lab work (lab technicians)., • Physical therapy: Assisting in the development and execution of physical therapy treatments (physical therapy assistants). Direct patient care: * • Assisting with patient mobility, bathing, feeding, or monitoring vital signs (patient care technicians, certified nursing assistants)., • Education and counseling: Providing patient education on treatments, conditions, and medications (health educators, dietitians)., • Rehabilitation support: Assisting patients in rehabilitative activities to improve mobility and function (occupational therapy assistants). Maintaining patient records: * • Ensuring that accurate medical documentation is up to date (medical record technicians)., • Scheduling and coordination: Arranging appointments, tests, or procedures for patients (medical office assistants). Billing and coding: * • Handling insurance claims and medical billing using appropriate coding systems (medical billers and coders)., • Operating specialized equipment: Such as in radiology, sonography, respiratory therapy, or anesthesiology. Sterilizing instruments: * • Ensuring that all medical instruments and environments are sterile (surgical technologists). Respiratory therapists: * • Provide breathing treatments and manage ventilators. Pharmacy technicians: * • Assist pharmacists in dispensing medications and providing information to patients. Requirements Authorized to work in the US without sponsorship This is NOT a Virtual/Remote position. Confirm you are willing to travel, if not already a local, to Texas, Louisiana, Tennessee or Arkansas Must have Certification applicable to the Medical Technician Specilaity English Equal Opportunity Employer Hire Energy provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Requisition #cm0gvsmvy2f1l0pnqys2tkgkl

Job Description 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, • 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. Pay Range: $18.77 - $28.09 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. #LI-Remote

Job Description The Payment Integrity Analyst is responsible for accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: • Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication., • Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits., • Utilize clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits., • Utilize applicable tools and resources to complete internal audits and/or appeals., • Timely completion of internal audits and/or appeals., • Attends Clinical Team Meetings, All Company Meetings, Education Opportunities, Trainings, and other potential meetings, • Ability to demonstrate understanding of CMS and commercial payer policy in written and verbal format, • Strong understanding of claims processing, ICD-10 Coding, DRG Validation, 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, • Demonstrate ability to manage multiple projects, set priorities and adhere to committed schedule, • Strong interpersonal skills and adaptive communication style, complex problem solving skills, drive for results, innovative, • Excellent written and verbal communication skills, • Proven track record of delivering concrete results in strategic projects/programs, • Strong analytical and modeling ability and distilling data into actionable results, • Superb attention to detail and ability to deliver results in a fast paced and dynamic environment EDUCATION/EXPERIENCE: • Must maintain a current LPN, LVN and/or RN licensure, • Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits, • Previous experience in one or more of the following areas required:, • Medical bill auditing, • 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, • Knowledge of worker's compensation claims process, • Prospective, concurrent and retrospective utilization review, • Bachelor’s degree in healthcare or related field preferred, • 1+ years healthcare revenue cycle, • 1+ years of relevant experience or equivalent combination of education and work experience, • 1+ years hospital bill audit 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: $63,902 – $96,662 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 Payment Integrity Analyst is responsible for accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: • Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication., • Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits., • Utilize clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits., • Utilize applicable tools and resources to complete internal audits and/or appeals., • Timely completion of internal audits and/or appeals., • Attends Clinical Team Meetings, All Company Meetings, Education Opportunities, Trainings, and other potential meetings, • Ability to demonstrate understanding of CMS and commercial payer policy in written and verbal format, • Strong understanding of claims processing, ICD-10 Coding, DRG Validation, 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, • Demonstrate ability to manage multiple projects, set priorities and adhere to committed schedule, • Strong interpersonal skills and adaptive communication style, complex problem solving skills, drive for results, innovative, • Excellent written and verbal communication skills, • Proven track record of delivering concrete results in strategic projects/programs, • Strong analytical and modeling ability and distilling data into actionable results, • Superb attention to detail and ability to deliver results in a fast paced and dynamic environment EDUCATION/EXPERIENCE: • Must maintain a current LPN, LVN and/or RN licensure, • Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits, • Previous experience in one or more of the following areas required:, • Medical bill auditing, • 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, • Knowledge of worker's compensation claims process, • Prospective, concurrent and retrospective utilization review, • Bachelor’s degree in healthcare or related field preferred, • 1+ years healthcare revenue cycle, • 1+ years of relevant experience or equivalent combination of education and work experience, • 1+ years hospital bill audit 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: $63,902 – $96,662 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 Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching various healthcare policies. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: • Assists with staff communication, providing updates, resolving issues, setting goals and maintaining standards as well as dialogue with team members in efforts to answer their questions and resolve barriers., • Oversees team member work for quality and compliance and communicates deadlines and productivity goals to team members while providing ongoing training and education to staff to ensure policies and procedures are followed., • Verifies and corrects as necessary, the audit work completed by PPI QC analysts and clinical appeal review teams as needed., • Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication., • Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits., • Utilize clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits., • Utilize applicable tools and resources to complete internal audits and/or appeals., • Timely completion of internal audits and/or appeals., • Attends Clinical Team Meetings, All Company Meetings, Education Opportunities, Trainings, and other potential meetings., • Ability to demonstrate understanding of CMS and commercial payer policy in written and verbal format, • Strong understanding of claims processing, ICD-10 Coding, DRG Validation, Coordination of Benefits, • Strong understanding of healthcare revenue cycle and claims reimbursement, • Proficient in Microsoft Office including Pivot Tables and Database Management, • Demonstrate ability to manage multiple projects, set priorities and adhere to committed schedule, • Strong interpersonal skills and adaptive communication style, complex problem-solving skills, drive for results, innovative, • Excellent written and verbal communication skills, • Proven track record of delivering concrete results in strategic projects/programs, • Strong analytical and modeling ability and distilling data into actionable results, • Superb attention to detail and ability to deliver results in a fast paced and dynamic environment EDUCATION/EXPERIENCE: • Must maintain a current LPN, LVN and/or RN licensure, • Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits, • Bachelor’s degree in healthcare or related field preferred, • 3+ years healthcare revenue cycle or payment integrity experience, • 3+ years of relevant experience or equivalent combination of education and work experience, • Previous experience in one or more of the following areas required:, • Medical bill auditing, • 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, • Knowledge of worker's compensation claims process, • Prospective, concurrent and retrospective utilization review 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: $71,696 – $110,701 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 Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding and clinically supported as defined by review methodologies specific to the type of review. This involves completing medical records review, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. Experience using ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. The ideal DRG Clinical Auditor candidate will have strong oral and written communication skills, clinical knowledge of disease process, and knowledge of medical necessity rules. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: • The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and supporting clinical documentation, • Conducting audits to ensure accurate reimbursement and identifying potential savings, • Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid, • The ability to work independently with minimal supervision and demonstrate initiative, • Able to communicate clearly and accurately, • Clearly understands and comply with all internal and external policies, • Working knowledge of HIPAA Privacy and Security Rules, • Ability to multi-task and assist with team coverage and provide support when needed, • Ability to build relationships both internally and externally, • Assists Quality Control team and medical director with Appeals, Rebuttals, etc., • Demonstrated proficiency in basic computer skills and typing, i.e., Microsoft Windows, Outlook, Word, PowerPoint, Internet Explorer, etc., • Notify manager/leadership of any issues or concerns in a timely manner, • Additional duties as assigned by leadership KNOWLEDGE & SKILLS: • Proficient in Medicare, CMS guidelines and ICD-10 coding guidelines, • Effective and professional communication skills, both verbal and written, • Ability to think and work independently, while working in an overall team environment, • Ability to work in a fast-paced environment, • Proficient in Microsoft Office Suite EDUCATION & EXPERIENCE: • Current LVN or RN license in the state of employment., • Current license must be maintained during employment, • CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS, • Experience in the OR, ICU, or ER as an RN highly preferred, • Extreme attention to detail, • Must possess critical thinking skills 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: $68,566 – $104,841 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 CERIS is seeking a Certified Coder. The CERIS Certified Coder reverse code previously coded medical bills to determine coding accuracy. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: • Receives claim and processes based on state rules and regulations, • Determine validity and compensability of the claim using CorVel proprietary programs, • Make recommendations to referring office, • Communicate claim status with referring office, • 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 EDUCTION & 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: $42,899 – $64,162 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 Appeals Representative is responsible for addressing provider inquiries and appeals via email, fax, telephone, or written correspondence ensuring adherence to client policy, industry standards along with CMS and state guidelines as well as client instructions. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: • Reviews, analyzes, and completes appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication, • Ability to appropriately interpret provider appeals and apply analytical thinking skills, • Ability to interpret client policy and CMS guidelines as it relates to reviews done by CERiS such as itemized bill, • Utilize applicable tools and resources to complete appeals, • Timely completion of appeals, • Additional duties as assigned KNOWLEDGE & SKILLS: • Prior knowledge of inpatient and outpatient hospital revenue cycle required, • Excellent written and verbal communication skills, • Contract interpretation, medical terminology and coding knowledge, • Proficiency with Microsoft applications EDUCATION & EXPERIENCE: • High school diploma or equivalent, • 3+ years of healthcare revenue cycle experience (collections, appeals, denials management, etc), • 2+ years working with customers in a fast‐paced, deadline‐oriented environment, • 2+ years experience as an Appeals Representative, • Strong attention to detail, organizational and time management skills with the ability to, • interpret, research and identify core issues, • Strong customer focus, analytical and decision making skills, • Strong technical skills with the ability to work across multiple software systems and comfortable work remote out of your home 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: $18.80 - $30.34 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. #LI-Remote

Job Description The Customer Service Representative is responsible for addressing client and/or provider inquiries via email, fax, telephonic, or written correspondence ensuring adherence to contractual and state guidelines as well as client instructions. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: • Take inbound calls and makes outbound calls as needed., • Analyzes client and provider inquiries to determine appropriate steps for resolution., • Performs review of claim history to ensure accurate information is communicated to internal and external customer., • Works directly with internal departments and management for resolution of Customer Service inquiries., • Able to accurately communicate CERIS findings to clients and providers in written and verbal format. KNOWLEDGE & SKILLS: • Excellent communication, verbal, written and organizational skills., • Prior knowledge of inpatient and outpatient hospital revenue cycle required., • Excellent written and verbal communication skills., • Contract interpretation, medical terminology and coding knowledge., • Proficiency with Microsoft applications EDUCATION & EXPERIENCE: • High school diploma or equivalent, • 2+ years working with customers in a fast-paced, deadline-oriented environment, • 2+ years experience as a Customer Service representative, • Strong customer focus, analytical and decision making skills 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: $13.63 - $21.00 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. #LI-Remote

Job Description The Payment Integrity Supervisor is responsible for the daily activities of payment integrity team related to quality assurance and provider appeals. The Supervisor manages and prioritizes staff daily work assignments necessary to ensure the timely and accurate processing of internal and external requests, interdepartmental quality audits and appeals. Additionally, the supervisor works to reduce response timeframes and mitigate future inquiries or escalations by being proactive, taking ownership of challenges, and formulating solutions to improve overall department activities while maintaining a focus on improving how we deliver service to our customers. This is a remote role. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: • Supervises all daily activities of payment integrity team related to quality assurance and provider appeals., • Ability to assist team with problem-solving, payer policy and clinical questions regarding audits performed by CERIS., • Ability to review and apply clinical knowledge along with payer policy to charges submitted on UB’s, itemized bills and medical records to determine accuracy of charges billed., • 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., • Ensures appeals and grievances are resolved in a timely manner., • Demonstrate ability to manage multiple projects, set priorities and manage to committed schedule., • Keeps manager informed of any issues that arise with appeals, quality assurance and/or team that cannot be resolved., • Act as a point of contact for internal departments to answer and resolve any questions related to appeals and quality assurance., • Prepare and distribute reporting materials and team training presentations as directed by the manager., • Maintain HIPAA privacy and security protocols., • Perform audits and/or appeal review as necessary., • Additional duties as assigned. KNOWLEDGE & SKILLS: • Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable), • Strong understanding of healthcare claims reimbursement, • Proficient in Microsoft Office including Excel and Word, • Strong interpersonal skills and adaptive communication style, complex problem-solving skills, drive for results, innovative, • Excellent written and verbal communication skills, • Ability to think and work independently, while working in an overall team environment, • Strong attention to detail and ability to deliver results in a fast paced and dynamic environment EDUCATION/EXPERIENCE: • Associate Degree in Nursing or higher required as applicable. BSN preferred., • Must maintain current licensure as a Registered Nurse in the state of employment as applicable., • Must maintain current coding certification as applicable., • Completes required CEUs to maintain Registered Nurse license and/or coding certification as applicable., • Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable, • 5+ years 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 preferred for non-DRG audits, • As applicable for DRG roles, • o CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10-PCS, • o Proficiency in both MS and APR DRG reimbursement methods, • o Demonstrated knowledge and understanding of clinical criteria documentation requirements used to successful substantiate code assignments., • 3+ years of relevant experience or equivalent combination of education and work experience, • 2+ years medical claims auditing of inpatient, outpatient and ASC claims preferred., • 2+ years of supervisory or management experience WORK CONTEXT: This description reflects CorVel’s assignment of essential functions, it does not proscribe or restrict the tasks that may be assigned nor does it restrict management’s right to assign or reassign duties and responsibilities of this job at any time. I acknowledge that I have read this description and by my signature below confirm that I am able to perform the essential functions of this position unaided or with the assistance of reasonable accommodation. 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: $76,207 – $117,662 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 CORVEL CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States 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

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