Independent Contractor-Hospital RN (Appeal Writing/Denials Mgmt) (Remote)

CorroHealth • Plano, TX

19h • Remote

About The Position

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 will be a generic IC profile for any clinician that is contracted to work with Corro. 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. As a Denial Management 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 the services performed during inpatient admissions. 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. CorroHealth has acquired Xtend Healthcare! For more information, please visit https://corrohealth.com.

Requirements

• RN or MD degree with strong clinical knowledge
• Active unrestricted clinical license in at least one state within the United States.
• Minimum of 5 years recent acute-care hospital experience
• Minimum of 2 years Utilization Review / Case Management experience within the last 5 years.
• Must have excellent attention to detail, written communication skills and be computer proficient.
• Must complete and pass a technical and inpatient clinical assessment.

Nice To Haves

• Managed care payor experience a plus in either Utilization Review, Case Management or Appeals.
• 5 years recent acute-care hospital experience, preferred.

Responsibilities

• Performs retrospective medical necessity reviews to determine appeal eligibility of clinical disputes/denials.
• Constructs and documents a succinct and fact-based clinical case to support appeal utilizing appropriate medical necessity criteria and other pertinent clinical facts.
• Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization.
• Demonstrates ability to critically think, problem solve and make independent decisions supporting the clinical appeal process.
• Queues of cases to be completed are provided from which work is self-assigned.
• Individual letters must be completed within 5 days of the assignment date.
• The consultant must provide a minimum of 20 letters each week.

What This Job Offers

• Job Type: Part-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree
• Number of Employees: 1,001-5,000 employees