• Researching overpayments in instances where payors (e.g., insurance companies or government programs) have paid more than the amount due, and fulfilling refund requests to our payors. • Initiating and managing refunds once verified, and ensuring the appropriate steps are taken to return funds. • Fulfilling overpayment requests based on the contractual timelines outlined by each payor. • Ensuring compliance with regulations and policies to ensure all actions follow federal, state, and payer-specific regulations. • Maintaining accurate records and keeping detailed documentation for transparency, audits, and process improvement.

• Provides coding and abstracting for mid-tiered complexity range of acute care services at all Banner hospitals • Reviews diagnosis and diagnostic information and codes and abstracts diagnoses and/or procedures on inpatient records using ICD CM and PCS coding classification systems • Completes MS-DRG and APR-DRG assignments on inpatient records as appropriate • Ensures ethical and accurate coding in accordance with all regulatory requirements and AHIMA Standards of Ethical Coding

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Ready to be the go-to person who helps patients access the care they need—when they need it most? If you're highly organized, skilled at follow-through, and bring experience in a medical office or healthcare setting, we want to hear from you! PCHC is looking for Referral Specialists to join our growing, mission-driven team. In this vital role, you’ll help patients navigate the referral process and connect them with the specialty care and services they need. We’re looking for someone who’s resourceful, detail-oriented, and passionate about making a real impact. If that sounds like you, apply today and help us deliver care that truly connects. Schedule: - Full-Time, Monday-Friday, 8:30am-5pm - Remote work possible after successful completion of 6 month training period and productivity assessment in Bangor, Maine. Candidate must be eligible per PCHC's Telecommuting Policy. Highlights of the position: - Provides excellent customer service to our patients, staff, and external customers by demonstrating friendliness, helpfulness, and proficiency. - Accurately and efficiently processes referral and prior authorization requests of all kinds. Verifies insurance benefits to ensure services are covered. - Liaisons and acts as point of contact with outside specialty offices regarding referrals. - Properly scans, imports, and processes patient health information related to referrals, ensuring all work is appropriate, compliant, and all protected information redacted. - Is a good steward of health information management. Understands and follows applicable HIPAA laws and regulations and PCHC medical records policies. - Assists in maintaining compliance with quality assurance standards. - Engages and supports patients to ensure they feel heard, respected, and involved in their care and experience. - Collaborates with Health Information Management teams and clinics to improve the patient experience and referrals processes. Qualifications - High school diploma or equivalent required. - Associates in Medical Office Technology, Health Information Management or other relative post-secondary degree is preferred. - Experience and proficiency using computer programs and software required. - At least one year of experience in a customer service setting required. - Two years of experience in a healthcare office setting strongly preferred. - Completion of a Medical Terminology I course preferred. Benefits - Join PCHC's nationally recognized non-profit organization. - Federally Qualified Health Center offering integrated Medical Home Model. - Collegial professional atmosphere with informed leadership. - Flexible schedules supportive of work/life balance. - Competitive compensation and generous benefits. - PCHC provides comprehensive, patient-centered care with integrated services, including Psychiatry & Mental Health, Dental, Family Medicine, Pediatrics, Pharmacy, Geriatrics, Laboratory Services, Physical Therapy, and more!

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The CERIS Certified Coder reverse codes previously coded medical bills to determine coding accuracy. This role is responsible for making claim-related recommendations and communicating status of the claim to involved stakeholders. This is a remote position. Essential Functions & Responsibilities - Receives claim and processes based on state rules and regulations - Determines validity and compensability of the claim using CorVel proprietary programs - Makes recommendations and communicates claim status to 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 - Maintain HIPAA compliance - Additional duties as assigned Qualifications - 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 (with surgical or office experience) - Current or recent orthopedic billing/coding experience - EncoderPro software experience - E/M coding/down-coding experience - Texas workers' compensation experience is preferred - Pain Management/Anesthesia/General Surgery coding experience is preferred Requirements - Ability to learn rapidly to develop knowledge and understanding of claims practices - Strong organizational skills - Ability to meet or exceed performance competencies - Effective and professional verbal and written communication skills - Ability to handle demanding situations while using critical and strategic thinking skills - 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, especially Excel and Outlook 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 the 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: $51,738 – $77,363 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!). CorVel is an Equal Opportunity Employer, drug-free workplace, and complies with ADA regulations as applicable.