Jobs at CorroHealth

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.

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.

Lead product development for hospital/provider revenue cycle software: translate stakeholder needs into user stories, maintain prioritized backlog, oversee sprints and releases, ensure acceptance criteria and usability, support enterprise Agile transformation, and coordinate with global teams and CAB.

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.

Perform retrospective coding audits and second-level reviews for professional fee (ProFee) encounters to ensure accurate diagnosis, procedure, and billing codes per AHA/CMS/AMA guidelines. Identify root causes of coding errors, provide coder feedback/training, suggest physician queries, prepare reports, and maintain QA standards and professional coding credentials.

Review and audit outpatient and professional fee hospital claims using proprietary PARA Data Editor. Identify coding, billing, and charge issues; apply CMS/payer rules, ICD-10-CM, CPT/HCPCS, NCCI/MUE edits; prepare reports, client education materials, and present findings. Support revenue cycle consulting team and maintain coding certifications and current knowledge.

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.