About CorroHealth:
At CorroHealth, our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable for achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
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JOB SUMMARY:
As a DRG Downgrade Appeals Clinician, you will have the unique opportunity to evaluate hospitalizations across the country while utilizing your medical knowledge and gaining experience as an expert advisor. You will perform retrospective clinical case reviews and draft appeals that focus on establishing the Medical Necessity of diagnosis in question by the payor or 3rd party audit firm.
Essential Duties and Responsibilities:
- Performs retrospective medical necessity reviews to determine appeal eligibility of clinical validation DRG Downgrade denials.
- Constructs and documents a succinct and fact-based clinical case to support appeal utilizing appropriate medical necessity criteria and other pertinent clinical facts. Pertinent clinical facts include, but are not limited to, documenting that the clinical criteria utilized in diagnosing the patient was appropriate.
- Adheres to all coding and clinical documentation guidelines as endorsed by ACDIS and AHIMA.
Minimum Qualifications & Competencies:
- RN or MD degree with strong clinical knowledge – Active unrestricted clinical license in at least one state within the United States.
- Certified in coding through either the AAPC (CPC/COC) or AHIMA (CCS/CCS-P)
- Minimum of 5 years recent acute-care hospital experience, preferred.
- Minimum of 2 years Utilization Review / Case Management experience within the last 5 years.
- Must have excellent written communication skills and be computer proficient.
DRG Downgrade Case Fee: $70/review (Review of Case with additional feedback for the case)
Job Types: Part-time, Contract
Medical specialties: Hospital Medicine
Physical setting: Acute care
Weekly schedule: Choose your own hours
Application Question(s): Are you a US citizen or Greed Card Holder?
Experience: Nursing: 1 year (Required)
License/Certification: Medical Coding Certification (Required), RN License (Required)
Work Location: Remote
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