Provider Relations Representative, Sr. jobs in Costa Mesa, CA

CorVel is hiring a Provider Relations Specialist for the Irvine, CA office. The Provider Relations Specialist assists providers via phone and email with basic to complex bill review questions and requests. Documents bill review errors for tracking and trending to improve team error rate. Acts as a positive and professional representative of our CorVel family; ensures compliance with company best practice standards; ensure consistent, timely delivery of our quality services.

This is a hybrid position during training. All trained Provider Relations team members are remote at this time, working from home after completion of training.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Communicate clearly and professionally with callers and via email.
• Understand CA Workers Compensation guidelines, MPN and Labor Codes and various client contract language to interpret and support our bill review.
• Maneuver in the bill review application to obtain accurate information for the callers.
• Understand CorVel EORs as well as client-specific nuances.
• Answer basic to complex State WC fee schedule and/or billing questions on processed medical bills covering regular as well as facility bill types
• Understand and be able to properly explain provider contracted rates, carve-outs and special LOAs applied to medical bills
• Requires regular and consistent attendance.
• Ability to control phone calls to ensure timely resolution and lower provider hold times.
• Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (“IIPP”).
• Additional duties as required.

KNOWLEDGE & SKILLS:

• Excellent oral and written communication skills
• PC literate, including Microsoft Office (Word, Excel)
• Strong knowledge of fee schedule and network contracts
• Strong customer service skills and experience
• Strong organizational skills
• Excellent interpersonal skills
• Ability to work in a team environment
• Ability to work independently

EDUCATION & EXPERIENCE:

• Associates’ degree preferred or comparable Workers Comp experience, typically level 2 Orange bill review skill set knowledge
• Knowledge of assigned State’s Workers’ Comp regulations
• CPC and/or expert in bill review analysis 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: $16.00 - $22.36 per hour

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

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-Hybrid