About Us:
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 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.
JOB SUMMARY:
CorroHealth is an innovative, rapidly growing organization that provides hospitals with comprehensive solutions focused on the intersection of utilization management, revenue cycle, and compliance. CorroHealth has expanded its product offering to include DRG Revenue Integrity services. CorroHealth provides programmatic solutions for DRG compliance and revenue integrity by leveraging advanced analytics and DRG auditing and clinical expertise. CorroHealth offers outstanding growth opportunities, a competitive salary and benefits package including bonuses based on individual and company performance, and reimbursement for continuing education and association dues. Versalus has a vibrant culture that strives to promote a positive work/life balance. Join our team and positively change healthcare!This is a remote position
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. 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.
Job Description:
TheDRG Appeals Specialistperformsreviewsof inpatient DRG payer denials on behalf of ourhospitalclient partners.Responsibilitiesinclude reviewingdenial letters,determinationanddata entry of audit recommendations,andresponsibility for professional and effective appeal responsesthat aresubmittedtimelyunderpayertimeframes.
Job Responsibilities:
- Performscomprehensive reviews ofinpatientmedicalrecordstovalidatethe MS/APR DRGs assigned for Medicare, Commercial,and Third-Party paidclaims.
- Validates that all ICD-10-CM/PCS, discharge disposition codes,andHospital Acquired Condition (HAC),Present on Admission (POA) indicatorsimpactingpaymentare documented, clinically supported,and assignedfollowingOfficial Coding Guidelines, compliant querypracticesandcurrent clinical validation criteria.
- Utilizes audit reference toolsandapplications (e.g., proprietary denials management application,TruCode,and3M encoder and grouper softwareandreferences).
- Reviews denial lettersrationale and formulatescustom appealresponselettersutilizingstrong critical thinking skills toindependentlyaccess cases for strengths and weaknesseswithin the appeals spectrum.Constructs and documents abriefand fact-basedcaseutilizingcompelling 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 lettersthatclearlysupport each appeal argument.
- Accurately abstracts denial audit findings into our proprietary applicationin accordance withstandard procedures.
- Maintains subject matter expertise in clinical validationcriteria and practices,ICD-10-CM/PCScode sets, coding guidelines, clinical documentation integrity,andinpatient payment methodologies.
- Attends continuing education workshops, webinars, etc., for coding anddocumentationintegrity and compliance.
- Other responsibilities as assigned. Duties may be subject to change at any time at the discretion of management, formally or informally, verbally or in writing.
RequiredEducation/Experience:
- RN/RHIA/RHITrequired.
- CCSwillberequiredafter one year of employment.(Assistance is available for preparation.)
- CDIP or CCDS is highly preferred.
- Certifications and/or professionallicensemust bemaintainedas a condition of employment.
- A minimumof5 years ofexperience in any of the following roles:
- Inpatient codingquality assurance
- DRG validation
- DRG appeal
- Clinical Documentation Integrity (CDI)as a Clinical Documentation Specialist (CDS), Educator, or Manager
Skills:
- ExtensiveInpatient Coding Skills.Possess regulatory ICD-10-CM/PCS codingexpertisecoupled with subject matterexpertisein MS/APR DRG payment methodologies,includingHospital Acquired Conditions (HACs), POA assignment, and Discharge Disposition codes.
- Clinical Validation Skills.Demonstratetheability toidentify, apply,andvalidatethe 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,managementand treatmentisrequired.
- Critical Thinking. Actively and skillfully conceptualizes, applies, analyzes, synthesizes, and evaluates information gathered from, or generated by observation, experience, reflection,reasoning,or communication as a guide tovalidateaudit results and correct,as necessary.
- Adaptability. Maintainseffectiveness when experiencing changes in work tasks or the work environment; 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.
- Initiative. Is proactiveandself-directed.Show initiativeandresponsibility in taking the necessary steps towards problem resolution.Isself-sufficient and does not need to rely on others to complete a job.
- Vivacity. Consistentlymaintainshigh levelsof activity or productivity sustained over long working hours when necessary;operateswith vigor, effectiveness, and determination.
- Performance.Meets or exceeds both productionandquality expectations while performing complex medical record audits.Able to executeunder pressure of time constraintsandwhile managing multiple responsibilities.
- Planning and Organization. Proactivelyprioritizesinitiatives, effectivelymanagesresourcesand canmulti-task. Actively manages their work assignments and seeksadditionaltasks when appropriate.
- Communication Skills. Communicates clearly, proactively,and concisely with all key stakeholders. Excellent written and verbal communication skills. Writes clear, compelling,accurate, and conciserationalesin support of findings and successfully crafts appeal letters with precise logic.
- Curious and Detailed Oriented. Actively seek outnew ideas, possibilities,andanswers to the tough questions.Pays meticulous attention to detail,identifiesaberrant 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. Committed to life-long learning.
- PC Skills. Demonstratesproficiencyin Microsoft OfficeandTeams,WebEx, VPN access, navigatingvariousEHRs, and abilityto problemsolve Internet connectivity issues.
Benefits
- Enjoy work-life balance with apredictableschedule
- 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
Physical Requirements:
May be expected to sit at a desk for long hours.Must have a private and secure space to work, including a secure Internet connection.Repetitive movement of hands and fingers – typing and/or writing. Occasional standing, walking, stooping, kneeling,or crouching. Ability toreach withhands and arms, talk,and hear. Exert up to 20 pounds of force occasionally and/or negligible amount of forcefrequentlyor constantlyto lift, carry, push, pull or otherwise move objects.
CorroHealth is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics,or any other basis forbidden under federal, state, or local law.
This is a remote position
PHYSICAL DEMANDS:
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. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.