Role Description The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position. Essential Functions & Responsibilities - Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication. - Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits. - Utilize applicable tools and resources to complete internal audits and/or appeals. - Timely completion of internal audits and/or appeals. - Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings. - Additional duties as assigned. Qualifications - Ability to use clinical judgment and analytical skills for claim audit review. - Knowledge of CMS/commercial payer policies, claims processing and reimbursements, IDC-10 Coding, and DRG Validation. - Familiarity with healthcare revenue cycle and coordination of benefits. - Proficiency in Microsoft Office, especially using pivot tables in Excel as well as database tools. - Excellent written and verbal communication skills. - Strong interpersonal skills across all levels; comfortable interfacing with clients and the C-Suite. - Ability to work on several concurrent tasks and prioritize workload to meet designated deadlines. - Advanced problem-solving and data analysis capabilities. - Proven track record of delivering actionable results. - Strong attention to detail. Requirements - Must maintain a current LPN, LVN and/or RN licensure. - Previous experience in one or more of the following areas required: - Medical bill auditing. - Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics. - Knowledge of worker's compensation claims process. - Prospective, concurrent and retrospective utilization review. - 1+ years healthcare revenue cycle. - 1+ years of relevant experience or equivalent combination of education and work experience. - 1+ years hospital bill audit. - Bachelor’s degree in healthcare or related field preferred. - Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits. Benefits - CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. - Pay Range: $66,941 – $101,258. - 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.

Role Description Services as the single point of contact throughout the duration of the onboarding experience by seamlessly executing on the implementing treasury services and products. Trains customers on the use of treasury products and services and provides a consultative approach to the onboarding experience. Coordinates with the operations team to ensure services meet customer expectations. Consistently communicates the status of implementation projects and requests to the Treasury Management sales team, operations and other applicable partners. Communicates any cross-sell opportunities to the sales team. Provides ongoing support to the treasury sales consultants and acts as a liaison between customers and service departments of the bank to support sales implementation and service issues. Interacts with various departments on an ongoing basis. Qualifications - Minimum Education: High school diploma or equivalent. - Minimum experience: Three years of Treasury Management or related experience such as retail or commercial operational banking experience with emphasis on opening new accounts. - Required Knowledge, Skills, & Abilities: - Working knowledge of Treasury Management applications, products and services. - Strong written and verbal communication and organizational skills, and attention to detail. - Strong organizational skills with attention to detail. - Strong customer service skills demonstrating a high degree of sensitivity to customer concern. - Ability to work under pressure and manage multiple tasks. - Proficiency using and understanding banking systems and applications. - Strong desire to proactively take ownership of requests and tasks in an effort to exceed the customer experience. - Proficiency using Microsoft Office software products. Requirements - Controls and manages the initiation, execution and review of Treasury Management customer agreements, implementation service exhibits, and other related documents required for product implementation. - Ensures customers complete all required documentation and documents are loaded in applicable systems correctly and within required timeframes. - Verifies services are implemented accurately and within expected timeframes to ensure service fee revenue. - Works with Information Technology to ensure direct file transmissions are implemented accurately and within established time frames. - Communicates implementation progress to sales team as required. - Monitors customer accounts to ensure customers receive services as requested and accounts comply with treasury management implementation procedures and bank policies. - Submits all exception pricing in applicable systems. - Provides customers with training demonstrations regarding treasury product installation, usage and troubleshooting of hardware and software. - Coordinates refresher and any other training with the sales and/or operations team. - Attends complex implementation calls as required. - Escalates potential roadblocks early in the process. - Ensures service and fulfillment related inquiries and requests are directed to the appropriate team and result in a highly satisfied customer experience. - Communicates resolutions to customers and serves as a liaison between the customer and Operations. - Identifies cross-sell opportunities and actively markets additional products to existing customers. - Keeps abreast of product updates and documentation. - Adheres to bank policies and procedures. - Maintains strong working knowledge of bank products, procedures, regulatory requirements, and industry issues through continuing internal and external training. - Contributes to special projects and system conversions as requested by manager. - Each team member is expected to be aware of risk within their functional area, observing all policies, procedures, laws, regulations and risk limits specific to their role. - Raises and reports known or suspected violations to the appropriate Company authority in a timely fashion. - Performs other related duties as required. Company Description

• Creates and presents reports and tools to department staff and leadership and ensures that information provided is understood and used appropriately. • Analyzes clinical performance in order to facilitate patient access to care. • Monitors utilization and demand metric and makes recommendations. • Documents business process improvements. • Monitors overbooking and under-booking of provider schedules. • Provides support to departments performing quality assurance checks on assigned schedules. • Supports the labor negotiation process by collecting information from HR systems and other sources, as appropriate. • Coordinates and oversees team initiatives and projects. • Provides coaching and training to less experienced analysts, as needed. • Adheres to University and unit-level policies and procedures and safeguards University assets.

• Implement approaches for systematically assessing needs in crisis-affected populations. • Incorporate traditional humanitarian data sources (e.g., needs assessments, poverty statistics, vulnerability indices, displacement monitoring, etc.) and novel data sources (e.g., geospatial imagery, call detail records, social media, crowd-sourcing, etc.) into GD’s targeting systems. • Provide clear targeting analysis with relevant subpopulations for emergency cash programs as a service to other teams, visualizing data on maps and dashboards. • Based on determined targeting criteria, general recipient lists of individuals to be enrolled in GD EC programs. • Provide targeting analysis services for both GD’s preparedness and response states – scoping and prioritizing relevant subpopulations based on pre-existing risks and delivering on-demand analysis during response deployments (remote). • Monitor global risks and crises, providing analysis for GD teams to make activation decisions. • Communicate with humanitarian agencies, data providers, and crisis monitoring organizations to integrate reliable event and assessment data into GD’s workflow. • Participate in product development from problem discovery and user requirements gathering to launch and iteration, working with engineering, data science, and operations. • Conduct agile iterative experiments and pilots to validate assumptions about crisis detection and targeting, using results to refine strategy. • Define and track success metrics for targeting tools, ensuring outputs are timely, relevant, and usable in the field. • Maintain internal data source documentation, including a qualitative assessment of accuracy, reliability, and limitations of sources and datasets. • Continuously evaluate and improve targeting approaches for speed, accuracy, and inclusivity, while maintaining humanitarian principles. • Stay abreast of emerging technology and new data sources to ensure GD is leveraging cutting-edge approaches to targeting. • Document learning to scale best practices across different contexts.