Registered Nurse Hospital -Urgent Needs!

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 achieving goals.

We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
The DRG Appeals Specialist performs reviews of inpatient DRG payer denials on behalf of our hospital client partners. Responsibilities include reviewing denial letters, determination and data entry of audit recommendations, and responsibility for professional and effective appeal responses that are submitted timely under payer timeframes.
Current and valid RN license
Medical necessity experience and appeal letter writing
Coding certification (AHIMA or AAPC) is a plus
This position requires up to 50% travel
Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.
CorroHealth offers outstanding growth opportunities, a competitive salary and flexible work environments. Join our team and positively change healthcare!
Performs comprehensive reviews of inpatient medical records to validate the MS/APR DRGs assigned for Medicare, Commercial, and Third-Party paid claims.

• Validates that all ICD-10-CM/PCS, discharge disposition codes, and Hospital Acquired Condition (HAC), Present on Admission (POA) indicators impacting payment are documented, clinically supported, and assigned following Official Coding Guidelines, compliant query practices and current clinical validation criteria.
• Utilizes audit reference tools and applications (e.g., proprietary denials management application, TruCode, and 3M encoder and grouper software and references).
• Constructs and documents a brief and fact-based case utilizing compelling clinical evidence from the medical record; supported by current industry clinical guidelines, evidence-based medicine, and official coding guidelines. Applies strong writing and grammar skills to formulate professional appeal letters that clearly support each appeal argument.
• Accurately abstracts denial audit findings into our proprietary application in accordance with standard procedures.
• Maintains subject matter expertise in clinical validation criteria and practices, ICD-10-CM/PCS code sets, coding guidelines, clinical documentation integrity, and inpatient payment methodologies.
• for coding and documentation integrity and compliance.
• Duties may be subject to change at any time at the discretion of management, formally or informally, verbally or in writing.

Active RN license in good standing required

• Assistance is available for preparation.) Professional license (RN) must be maintained as a condition of employment.
• Inpatient coding quality assurance
• Extensive Inpatient Coding Skills. Possess regulatory ICD-10-CM/PCS coding expertise coupled with subject matter expertise in MS/APR DRG payment methodologies, including Hospital Acquired Conditions (HACs), POA assignment, and Discharge Disposition codes.
• Demonstrate the ability to identify, apply, and validate the use of current industry standard clinical indicators, risk factors and treatment protocols used in clinical validation of payment impacting code assignment. Solid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, management and treatment is required.
• adapts to change in environment and/or circumstances with a positive outlook and adjusts effectively to work within new work structures, processes, requirements, or cultures.
• Performance . Meets or exceeds both production and quality expectations while performing complex medical record audits. Planning and Organization . Pays meticulous attention to detail, identifies aberrant code assignment, mines medical records for all relevant and supporting evidence, intuitively understands appeal strategies and conscientiously follows all steps in the audit and appeals process. Demonstrates proficiency in Microsoft Office and Teams, WebEx, VPN access, navigating various EHRs, and ability to problem solve Internet connectivity issues.

Compensation includes salary plus bonus opportunities

• Medical, Dental, Vision coverage, 401K
• Holidays, paid time off, short term and long-term disability insurance, and life insurance
• Reimbursement for continuing education and association dues

This is a hybrid position - requires 50% travel
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs.