Clinical RN Specialist

CorroHealth • NJ-Remote, NJ

3d • Remote

About The Position

At CorroHealth, 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. This is a remote position within the US only. The schedule is full-time, Monday - Friday. As a DRG Downgrade Appeals Clinician, you will have the unique opportunity to evaluate hospitalizations across the country while utilizing your medical knowledge and gaining experience as an expert advisor. You will perform retrospective clinical case reviews and draft appeals that focus on establishing the Medical Necessity of diagnosis in question by the payor or 3rd party audit firm. CorroHealth sits at the center of the revenue cycle revolution. Fundamental operations of the revenue cycle are supported through our expert teams while we recast the role of clinicians through automation. This shift to a true clinical revenue cycle helps us achieve our core purpose – exceed client financial health goals. For each patient population, CorroHealth automates key clinical aspects of the cycle. Our platforms focus on capture and application of clinical documentation while easing the burden on physicians. Scalability is prioritized in the support of client program operations. As with most revenue cycle partners, our skilled and enthusiastic team is available to outsource any portion of the cycle. However, we can also complement client programs with additional expert support or upskill existing client teams to meet program demands. Whether our team is deployed directly, or automation is incorporated for a more programmatic solution, CorroHealth delivers.

Requirements

• RN or MD degree with strong clinical knowledge
• Active unrestricted clinical license in at least one state within the United States.
• Certified in coding through either the AAPC (CPC/COC) or AHIMA (CCS/CCS-P)
• Excellent written communication skills
• Computer proficient

Nice To Haves

• Minimum of 5 years recent acute-care hospital experience
• Minimum of 2 years Utilization Review / Case Management experience within the last 5 years.

Responsibilities

• Performs retrospective medical necessity reviews to determine appeal eligibility of clinical validation DRG Downgrade denials.
• Constructs and documents a succinct and fact-based clinical case to support appeal utilizing appropriate medical necessity criteria and other pertinent clinical facts.
• Documents that the clinical criteria utilized in diagnosing the patient was appropriate.
• Adheres to all coding and clinical documentation guidelines as endorsed by ACDIS and AHIMA.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior