DRG Appeals Specialist, RN

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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CorroHealth

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

CorroHealth is a leading provider of clinically led healthcare analytics and technology-driven solutions, focused on enhancing the financial performance of hospitals and health systems. Their integrated solutions and advanced technologies aim to optimize the entire revenue cycle, offering services such as revenue cycle management, clinical documentation, medical coding, and denials management. With a commitment to improving financial health through intelligent technology and expert guidance, CorroHealth addresses complex payer-provider relationships and supports efficient healthcare operations.

📋 Description

• Review inpatient DRG payer denials for hospital client partners • Review denial letters and determine and enter audit recommendations • Prepare professional, timely appeal responses within payer timeframes • Review inpatient medical records to validate MS/APR DRGs for Medicare, Commercial, and Third-Party paid claims • Validate ICD-10-CM/PCS codes, discharge disposition codes, HACs, and POA indicators for documentation, clinical support, and coding compliance • Use denial-management applications, TruCode, and 3M encoder and grouper software and references • Analyze denial rationales and independently assess case strengths and weaknesses • Construct fact-based appeal cases using clinical evidence, industry guidelines, evidence-based medicine, and official coding guidelines • Write clear, compelling, accurate, and concise appeal letters • Abstract denial audit findings into the proprietary application • Maintain subject matter expertise in clinical validation, ICD-10-CM/PCS, coding guidelines, CDI, and inpatient payment methodologies • Attend continuing education workshops and webinars • Perform other assigned responsibilities

🎯 Requirements

• RN, RHIA, or RHIT required • CCS required after one year of employment • CDIP or CCDS highly preferred • Certifications and/or professional license must be maintained as a condition of employment • Minimum of 5 years of experience in inpatient coding quality assurance, DRG validation, DRG appeal, or Clinical Documentation Integrity as a Clinical Documentation Specialist, Educator, or Manager • Extensive inpatient coding skills • Regulatory ICD-10-CM/PCS coding expertise • Subject matter expertise in MS/APR DRG payment methodologies, including HACs, POA assignment, and Discharge Disposition codes • Ability to identify, apply, and validate current industry-standard clinical indicators, risk factors, and treatment protocols • Solid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, management, and treatment • Strong critical-thinking skills • Ability to meet production and quality expectations while performing complex medical record audits • Ability to execute under time constraints and manage multiple responsibilities • Excellent written and verbal communication skills • Proficiency in Microsoft Office, Teams, WebEx, VPN access, navigating various EHRs, and troubleshooting Internet connectivity issues • Must have a private and secure workspace and secure Internet connection

🏖️ Benefits

• Competitive salary and benefits package • Bonuses based on individual and company performance • Reimbursement for continuing education and association dues • Predictable schedule • Medical coverage • Dental coverage • Vision coverage • 401K • Holidays • Paid time off • Short-term disability insurance • Long-term disability insurance • Life insurance • Assistance with CCS preparation • Remote position • Work-life balance