North Carolina Licensed Review Analyst

Job Summary

A company is looking for a Professional Review Analyst I to analyze medical services and billing for accuracy and necessity.

Key Responsibilities

• Identify review process necessity and communicate issues to claims examiners or managers
• Collect and analyze data to evaluate billing appropriateness and care delivery
• Document work and conclusions in the designated computer program

Required Qualifications, Training, and Education

• Associate's degree or equivalent experience
• CPC or CPC-A certification required
• Preferred experience in medical bill auditing
• Knowledge of workers' compensation claims process
• Experience with prospective, concurrent, and retrospective utilization review