Appeals Team Lead

The Appeals Team Lead assists injured workers, claims examiners, attorneys, providers, etc. in locating providers within the medical provider network (MPN), verifying provider inclusion in an MPN and scheduling appointments upon request for the injured worker. This position includes a moderate volume of inbound calls and a high volume of outbound calls. This role is responsible for documenting bill review errors to improve team error rate trend.

The Provider Relations Specialist acts as a positive and professional representative of our Cor Vel family. The role ensures compliance with company best practice standards while also enabling a consistent, timely delivery of our quality services.

This is a remote position.

ESSENTIAL FUNCTIONS & 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 time frames
• 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 Cor Vel
• 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 Cor Vel 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

KNOWLEDGE & SKILLS:

• 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

EDUCATION & EXPERIENCE:

• Associates' degree preferred or comparable Workers Comp experience
• Knowledge of assigned State's Workers' Comp regulations
• CPC and/or expert in bill review analysis preferred
• Call center experience a plus but not required

PAY RANGE:

Cor Vel 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 Cor Vel website:
Cor Vel 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:

Cor Vel, 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. Cor Vel 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…