Teams 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.