CERIS · 3 days ago
Appeals Team Lead
United States
Contract
Remote
Mid, Senior Level
$18.80/hr - $30.34/hrCorVel is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. The Appeals Team Lead assists injured workers and other stakeholders in navigating the medical provider network while ensuring compliance with company standards and delivering quality services.
Health CareMedicalPayments
Responsibilities
Receive incoming calls, emails and faxes from the Medical Access Assistant line
Communicate clearly and professionally with providers and other stakeholders via phone and email
Provide excellent customer service and act as network liaison to injured workers, claims examiners and providers
Understand Workers Compensation guidelines and various client contract language to interpret and support our bill review
Navigate the bill review application to obtain accurate information for the callers
Triage requests and ensure they are completed within required timeframes
Locate providers of a particular specialty within a designated area as requested by the caller
Verify providers are within a specified network and/or have a contract with CorVel
Schedule appointments for injured workers upon request
Assist callers in navigating our website directory
Call providers to verify demographic information (address, phone number, WC acceptance, etc)
Answer questions from callers regarding their MPN; transferring the caller to the appropriate department if we are unable to assist
Work with the Network Relations team to correct any discrepancies in the database
Communicate to the contract developers if there is a need for certain specialties in a geographic area
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, and carve-outs applied to medical bills
Additional duties as assigned
Qualification
Required
Excellent oral and written communication skills
Working knowledge of Microsoft Office (Word, Excel)
Strong knowledge of fee schedule and network contracts
Strong customer service skills and experience
Strong organizational skills
Ability to work independently and in a team environment
Effective quantitative, analytical and interpretive skills
Strong interpersonal, time management and analytical skills
Ability to control phone calls to ensure timely resolution and lower provider hold times
Knowledge of assigned State's Workers' Comp regulations
Preferred
Associates' degree preferred or comparable Workers Comp experience
CPC and/or expert in bill review analysis preferred
Call center experience a plus but not required
Benefits
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
Paid time off
Company
CERIS
CERiS is a company that detects and resolves payment issues for health claims.
Founded in 1990
501-1000 employees
Funding
Current Stage
Late StageRecent News
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