CERIS

Role Description The Itemization Review Supervisor will maintain a positive team building approach with emphasis on reporting, leadership and professional communication with all CERIS departments. This is a remote position. Essential Functions & Responsibilities: - Maintain accurate, current data and analytics to support informed decision-making and reliable outcomes - Manage and track client appeals as required - Oversee the file assignment process and continuously monitor nurse workloads and queues - Ensure daily prioritization of all claims is clearly understood and executed - Prepare and maintain monthly metrics and reporting - Demonstrate working knowledge of CERIS systems and databases - Lead and support the team with minimal managerial oversight - Foster a collaborative and positive work environment through effective team leadership - Ensure strict adherence to HIPAA compliance standards - Additional duties as assigned Qualifications - Comprehensive knowledge of departmental policies and procedures related to Itemization Review - Advanced understanding of client payment policies as they apply to reviews - Familiarity with quality control processes - Strong organizational, strategic thinking, and critical analysis skills - Excellent written and verbal communication skills - Ability to manage high-pressure situations and adapt to changing priorities - Proven leadership, problem-solving, and analytical capabilities - Ability to work both independently and collaboratively - Skilled in organizing and facilitating monthly team meetings with a focus on training and development - Proficiency in MedCheck, MedCheck Select, CareMC, Tableau, UKGPro, departmental policies and procedures, and Microsoft Office Suite (including Excel, Outlook, and Teams) Requirements - Must maintain current licensure as a Registered Nurse (RN) in the state of employment - Must have a minimum of 5 years’ experience in the O.R., ICU, or E.R. as an R.N. - At least 3 years of experience in a hospital supervisor or manager role - Associate Degree in Nursing or higher - Minimum of 3 years’ experience in LIBR preferred - Experience in medical bill auditing preferred - Knowledge of ICD-10, DRG and coding preferred Benefits - Comprehensive benefits package available for full-time regular employees - 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 and ROTH 401K - Paid time off Company Description 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!).

Role Description The Itemization Review Coordinator is responsible for maintaining a consistent workflow by distributing claims to Quality Control and Itemization Review Nurses. This is a remote position. - Monitor incoming and existing claims and distribute to staff based on priority and due date - Maintain and update departmental spreadsheets and attendance calendar per supervisor request - Ensure an even and fair distribution of claims to staff - Notify staff of priority claim assignments - Notify supervisor(s) of claims requiring/receiving extensions - Notify supervisor(s)/management of backlog files, late files, low census, and waiting list - Update SharePoint website as required - Assist supervisor(s)/management to identify potential issues in a proactive manner - Maintain/update/assist with all New Hire documentation/packets - Maintain supplies for department - Assist Education Nurse(s) with updating syllabus and creating training manuals - Maintain HIPAA compliance in all aspects of communication - Additional duties as assigned Qualifications - Ability to maintain accuracy during data entry - Proficient in Microsoft Office Suite, Outlook, Excel and Word - Detail oriented - Exceptional organizational skills - Ability to work independently in a fast-paced production environment - Effective written and verbal communication skills - Ability to type at least 60 wpm Requirements - High School Diploma or equivalent experience required - 6 months to 1 year office experience Benefits - 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 - Paid time off Company Description 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!).

Role Description The CERIS Policy & Payment Integrity Coordinator (PPI Coordinator) plays a key role in supporting the Policy and Payment Integrity teams by managing workflow, ensuring timely assignment of appeals, and maintaining accurate tracking systems. This position requires strong organizational skills, attention to detail, and the ability to manage multiple priorities in a fast-paced environment. This is a remote position. Essential Functions & Responsibilities: - Manage and monitor general PPI department mailboxes to ensure timely review and routing of incoming correspondence - Assign appeals to appropriate team members based on established workflows and production needs - Maintain and update appeal trackers to ensure accurate and current data is available for reporting and performance monitoring - Track the status of assigned appeals to support timely completion and compliance with internal expectations and external deadlines - Identify workflow delays or discrepancies in tracking systems and escalate to leadership as appropriate - Collaborate with supervisors and team leads to balance workloads and support production goals - Assist with preparing reports, summaries, or metrics related to appeals volume, assignments, and completion rates - Support special projects, audits, and process improvements as directed by leadership - Maintain confidentiality and compliance with organizational policies and applicable regulations - Additional duties as assigned Qualifications - Strong organizational and time management skills with the ability to prioritize tasks effectively - Excellent written and verbal communication skills - Strong attention to detail and accuracy - Ability to work both independently and collaboratively within a team environment - Proficiency in Microsoft Office applications (Excel, Outlook, Word) and ability to learn internal systems Requirements - High school diploma or equivalent required Benefits - 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 - 401 K - ROTH 401 K - Paid time off Company Description 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!).

Role Description The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position. Essential Functions & Responsibilities: - Collects supporting data and analyzes information to make decisions regarding accuracy of billing - Appropriately documents work and final conclusions in designated computer program - Understanding of Surgical Implants - Meets department's expectations and standards - Additional duties as assigned Qualifications - Understanding of Itemization Review for designated clients - Understanding of CERIS systems and Data Base informatics - Understanding of HIPAA regulations - Exceptional organizational skills with the ability to handle stressful situations and adapt accordingly - Demonstrated leadership skills; ability to work with Leadership Team(s) within a positive team environment - Strategic problem solving, analytical, and critical thinking skills - Effective written and verbal communication skills - Ability to work independently and within a team environment - Proficiency with Microsoft Office Suite, including Excel, Outlook, Teams Requirements - Must maintain current licensure as a Registered Nurse in the state of employment - Must have a minimum of 5 years’ experience in the O.R., ICU, or E.R. as an R.N. - Associate Degree in Nursing or higher - Experience in medical bill auditing preferred but not mandatory Benefits - Comprehensive benefits package for full-time regular employees - 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 Description 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!).

Role Description The Closing Analyst is responsible for closing client files and applying results into Scheck and CareMC systems to meet daily production expectation and standards. This is a remote position. Qualifications - Detail Oriented with Good organizational skills - Effective and professional communication skills - Demonstrated problem solving, and analytical skills - Ability to think and work independently, while working in an overall team environment - Ability to work in a fast paced/production environment Requirements - Close client files in the appropriate manner, dictated by client protocol - Ensure all appropriate documentation is attached and follow departmental QC protocols - Complete special task assigned by supervisor/manager - 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 Benefits - Comprehensive benefits package for full-time regular employees - 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 Description 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!).

Role Description The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, and industry standards, along with CMS and state guidelines. This role ensures that all appeals are set up accurately and in a timely manner, supporting the appeal process efficiently. Essential Functions & Responsibilities: - Receiving and analyzing appeal documentation to determine appropriate actions - Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents - Ensure compliance with HIPAA, CMS guidelines, and client instructions and policy standards - Utilize applicable tools and resources to complete setup - Additional duties as assigned Qualifications - Knowledge of Medicare, Medicaid, and commercial insurance guidelines - Strong attention to detail, time management, and organizational skills - Excellent written and verbal communication skills - Knowledge of medical terminology and CPT/ICD codes - Proficiency with Microsoft applications Requirements - High school diploma or equivalent - 1+ years of experience in healthcare, insurance, claim processing, or customer service - 1+ years working with customers in a fast-paced, deadline-oriented environment - 1+ years of experience as an Appeals Representative - Strong technical skills with the ability to work across multiple software systems and work remotely with self-management skills 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 - 401 K - ROTH 401 K - Paid time off Company Description 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!).

Role Description The Recovery Supervisor is responsible for analysis and monitoring of claims audit data across multiple platforms. 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 claims processing. 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 position. Qualifications - 5+ years of relevant experience in a medical or insurance field, which required heavy involvement in bill review processing of claims - 2+ years of previous supervisory/management or project management experience a plus - 3+ years of relevant experience or equivalent combination of education and work experience - Associate degree or higher preferred - Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable Requirements - Manage team performance by setting and communicating standards and deadlines, measuring results, and providing feedback - Maintain positive morale by leading the team through example and accountability with a focus on helping each member achieve their best performance - Assists leadership in obtaining complex information from various financial, clinical and operational systems and data sources - Ability to assist with pricing of claims according to provider contracts - Ability to assist team with problem solving regarding customer complaints, or inquiries, including bill review disputes verbally and in written communication - Identifies, quantifies and monitors account detail or workflow processes for barriers - Makes process improvements or initiates courses of action for problem resolution - Analyzes all forms of Revenue Cycle transactions and provides trend analysis - Produces daily, monthly and annual evaluative and statistical reports, analyzing drivers of variances from period to period in order 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 - Participates in the panel interviews, prepares new hire documentation, facilitates associate orientation, and participates in the termination process - Independently leads initiatives as assigned by management, coordinating task teams or other forums to deliver results as identified and/or determined by leadership - Ability to review and understand case rates, per diems, percentage of discounts, and provide detailed charges and costs per claim - Handles escalated requests from client and/or executive leadership - Ensure strict confidentiality of all medical records, PHI, and PII - Additional duties as assigned Benefits - Comprehensive benefits package available for full-time regular employees - 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 and ROTH 401K - Paid time off 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. Pay Range: $24.30 - $36.30 per hour

Role Description The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, and industry standards, along with CMS and state guidelines. This role ensures that all appeals are set up accurately and in a timely manner, supporting the appeal process efficiently. This is a remote position. Essential Functions & Responsibilities - Receiving and analyzing appeal documentation to determine appropriate actions - Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents - Ensure compliance with HIPAA, CMS guidelines, and client instructions and policy standards - Utilize applicable tools and resources to complete setup - Additional duties as assigned Qualifications - Knowledge of Medicare, Medicaid, and commercial insurance guidelines - Strong attention to detail, time management, and organizational skills - Excellent written and verbal communication skills - Knowledge of medical terminology and CPT/ICD codes - Proficiency with Microsoft applications Requirements - High school diploma or equivalent - 1+ years of experience in healthcare, insurance, claim processing, or customer service - 1+ years working with customers in a fast-paced, deadline-oriented environment - 1+ years of experience as an Appeals Representative - Strong technical skills with the ability to work across multiple software systems and work remotely with self-management skills 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 - 401 K - ROTH 401 K - Paid time off Company Description 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!).

Role Description The Quality Control Nurse is responsible for ensuring and maintaining MCS Bill Review database integrity. Ensures timely application of QC protocols to meet production standards. This is a remote position. Essential Functions & Responsibilities - Analyses itemization line item descriptors from hospital billing entered - Verifies line item data sets for completeness, correctness and understandability - Maintain the integrity of each provider chargemaster within Scheck - Maintains consistent communications with the Data Entry Analyst on line item entries - Maintains constant communications with the Medical Review Department regarding unusual billing practices and discovery of potential errors - Maintain 100% accuracy of data set(s) PRIOR to moving files to the next department to meet production and turnaround time requirements - Maintain HIPAA compliance in all aspects of communications - Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) - Additional tasks as required by Supervisor Qualifications - Exceptional organizational, strategic and critical thinking skills - Effective and professional communication skills - Ability to handle stressful situations and adapt accordingly - Demonstrated outstanding leadership, problem solving, and analytical skills - Ability to think and work independently, while working in an overall team environment - Proficient in MedCheck Select V5.0, Microsoft Office Suite, Excel, Outlook, and Skype for Business Requirements - Must maintain current licensure as a Licensed Practical Nurse or Registered Nurse in the state of employment - Must have a minimum of 5 years’ experience in the O.R., ICU, or E.R. as an R.N. or 10+ years of patient care in a medical setting - Current license or Associate Degree in Nursing or higher - Experience in medical bill auditing, preferred but not mandatory Benefits - Comprehensive benefits package for full-time regular employees - 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 Description 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!).

Role Description Responsible for assisting and supporting their direct supervisor with ensuring their team meets protocol as well as performing supervisor duties if & when the supervisor is out. Also, responsible for ½ production. This is a remote position. Essential Functions & Responsibilities - Must maintain ½ production quota - Organize and distribute claims according to established priority - Provide guidance to analysts, aiding with resolution of problems or questions - Process complex/problematic claims according to protocol - Maintain production standards and production requirements - Comply with standard protocol for processing problem claims - Function as liaison between analysts and clients - Professionally communicate with other offices and internal departments - Train new employees - Requires punctual and consistent attendance, and commitment to work overtime as required - Assist co-workers, supervisor and management in accomplishing production goals - Maintain HIPAA compliance in all aspects of communications and performance of duties - Other duties as assigned Qualifications - Proficient in Microsoft applications - Detail Oriented - Ability to QC departmental work product and correct when applicable - Exceptional organizational skills - The ability to work independently, as well as with a team - The ability to work in a fast paced/production environment - Ability to investigate and obtain answers independently - Ability to demonstrate leadership capabilities and independent thinking - Effective and professional communication skills - Demonstrated problem solving skills and analytical skill Requirements - High school diploma or equivalent - Minimum 1 year as a Setup Analyst - Data Entry experience 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: $15.61 - $23.82 per hour Benefits 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 - Paid time off Company Description 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!).