Jobs at CorroHealth

Provides remote clinical review of inpatient and outpatient medical records for medical necessity, level of care, authorization compliance, and payer guideline alignment. Prepares appeals for DRG downgrades and clinical validation denials, identifies documentation gaps, applies payer criteria, documents findings, meets turnaround times, and escalates complex cases. Requires an active unrestricted RN license and substantial clinical review, utilization review, appeals, or DRG experience.

Audits inpatient, outpatient, and physician practice coding using medical record documentation and official coding guidelines. Identifies errors and root causes, prepares client reports, performs compliance reviews, researches coding and denial inquiries, and develops coding education. Maintains audit accuracy and productivity standards, protects patient confidentiality, collaborates with clients and consulting teams, and maintains professional coding credentials. This is a remote role with periodic travel.

Coordinates peer-to-peer appeal activities by contacting payers to schedule calls with medical directors, following up on overdue cases, documenting payer communications, and updating account statuses across multiple databases. Provides case-entry, peer-to-peer, and appeals support while maintaining confidentiality and HIPAA/HITECH compliance. The role requires extensive phone communication, accurate documentation, multitasking across systems, problem-solving, and collaboration in a remote, fast-paced environment.

Audits zero-balance hospital accounts to identify underpaid inpatient and outpatient claims. Reviews payer contracts, medical records, policies, regulations, and payment data; models reimbursement methodologies; researches underpayment trends; and develops audit plans, pricing documents, and technical procedures using Excel, Access, and SQL. Senior auditors lead complex investigations, provide quality reviews, mentor staff, and recommend process improvements.

Lead and scale a remote clinical appeals letter-writing team, ensuring clinical accuracy, QA, hiring/onboarding, performance management, and alignment with revenue-cycle KPIs. Serve as clinical SME for clients, drive process improvements, manage domestic and global clinicians, participate in escalations, and ensure DRG downgrade and appeals expertise informs operational and financial outcomes.

Analyze and investigate incorrectly paid medical insurance claims, pursue underpayments via phone and written appeals, review hospital claims and payer contracts, mentor and train junior analysts, manage multiple projects, and communicate results with auditors and clients to maximize reimbursement and profitability.

Lead and continuously improve pre-bill DRG validation, QA, and training programs to ensure coding accuracy and compliance. Oversee audits, performance benchmarks, second-level adjudication, cross-functional collaboration with CDI, physician advisors, compliance and revenue cycle, and manage a team, budget, and reporting to reduce DRG mismatches, denials, and revenue leakage.

CDI Specialists collaborate with healthcare teams to improve clinical documentation quality, ensuring accuracy for coding and reporting outcomes. They conduct reviews, issue queries, and meet productivity standards while adhering to guidelines.

Remote insurance specialist responsible for identifying and resolving hospital and professional fee (profee) claims denials and processing errors. Uses EMR systems and proprietary software, reviews UB04s, EOBs, and medical records, contacts payers, and follows client preferences to achieve production and quality targets while complying with HIPAA.

Configure and manage Epic charge capture and billing modules, document and improve charge-capture workflows, build Epic order sets and preference cards, train staff, collaborate with coding and revenue integrity teams, ensure CDM and compliance, advise on Medicare/Medicaid reimbursement, lead client meetings, produce written guidance, and travel quarterly to client sites.

Remote role resolving outstanding insurance balances for hospital and physician accounts. Perform account research in client systems (including Prism), prepare appeals, follow client and federal guidelines, meet cash and quality targets, document actions, and maintain compliance with HIPAA, FDCPA, and related regulations.

Remote PRN clinical review nurse who performs medical necessity and authorization reviews for inpatient/outpatient records, applies payer guidelines, drafts appeals, documents findings, and meets turnaround and quality expectations to support appeal submissions and inventory management.

The DRG Revenue Integrity Auditor performs audits on inpatient charts to ensure coding accuracy and compliance with clinical guidelines. Responsibilities include chart reviews, training new hires, and maintaining coding best practices while analyzing data for client reporting.

Supervise DRG coding audits, ensuring compliance with coding guidelines, provide training, conduct quality assurance, and generate reports for clients.

Review outpatient medical records to improve documentation specificity and completeness, query providers per AHIMA guidance, support accurate problem lists and risk adjustment (HCCs), collaborate with coding/quality/revenue teams, track CDI interventions, ensure compliance with CMS and payer rules, and provide provider education.