CorroHealth

Manager

• Oversee the investigation and resolution of third-party insurance coding denials and edits for CorroHealth clients
• Assist in the supervision of optimizing reimbursement by thoroughly researching and taking timely, appropriate action to ensure resolution of all coding denials.
• Review and research coding denials that have been received as no payment/previous submitted claims with a denied or no response for payors and service areas
• Identify root cause of the coding denial, resubmit claim and address/report the denial issue to leadership
• Assists in development of preventative measures in response to denial patterns identified by claims denial data and reviews
• Obtain and review medical records through EMR, site request or hospital portals for reconsideration purposes
• Utilizes all appropriate systems to effectively research claims and complete steps to submit information necessary to process or appeal denied claims
• Comply with adjustment and appeal or reconsideration in conjunction with each service area's Coding and Reimbursement guidelines
• Effectively utilizes ICD 10 CM and CPT codes and related material to investigate and ensure that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims
• Organizes work/resources to accomplish objectives and meet timely filing deadlines
• Demonstrates problem-solving skills related to coding denial analysis
• Demonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively, to obtain necessary information to address denial issues
• Meets productivity requirements to ensure excellent service is provided to customers
• Adheres to compliance and corporate and departmental policies and procedures
• Identifies all coding denial trends and provide education of steps to prevent future avoidable denials
• Initiates and responds all coding appeals in a timely manner
• Logs and tracks all coding denial trends and coding denial increases on coding log
• Completes special projects as assigned by Director
• Maintains and utilizes accurate and current coding resource materials when making determinations for claim reconsiderations and appeals
• Performs other projects and duties as related to the overall organization's objectives
• Maintains confidentiality of all information as stipulated in the HIPAA Privacy Rules and Company Confidentiality Policy
• Maintain daily and monthly productivity goals – set depending on service area/payor assignment

Coding Denials Manager

Medical Billing and Coding

• Provide various components of coding services to support our clients
• Outpatient surgery coder proficient with CPT procedure codes and modifiers as well as ICD-10 diagnosis codes
• Apply ICD-10-CM diagnosis codes to the highest level of specificity available
• Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS
• Interpret coding guidelines for accurate code assignment
• Identify the importance of documentation on code assignment and the subsequent reimbursement impact
• Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and support the Company’s Ethics and Compliance Program
• Comply with all internal policies and procedures

Outpatient Facility SDS Coder

• Provide various components of coding services to support our clients.
• Calculate ProFee and/or Facility E/M levels by using an algorithm created by our company.
• Recognize critical care cases by patient acuity.
• Code surgical procedures typical of an ER setting to capture additional revenue when appropriate.
• Apply ICD-10-CM diagnosis codes to the highest level of specificity available.
• Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS.
• Interpret coding guidelines for accurate code assignment.
• Identify the importance of documentation on code assignment and the subsequent reimbursement impact.
• Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and support the Company’s Ethics and Compliance Program.
• Comply with all internal policies and procedures.
• Actively participate in Company provided training and education.

Outpatient Same Day Surgery Coding Specialist

Account Executive

• Manage client projects and relationships by participating in meetings, managing action items through to completion, answering client questions, and independently writing client emails
• Compile, QA, and independently manage client processes from start to finish, such as provider relation escalations, bulk issues, regular reports, and invoices
• Manage internal staffing and project needs, including answering questions from other team members on assigned client and monitoring project profitability
• Research and determine next steps for complex and new payer issues and reimbursement areas to uncover potential opportunities, such as reimbursement guidelines and healthcare legislation
• Create and update project plans, including outlining potential risk areas of a hospital-payer contract based on reimbursement structure and how to manually identify within the data
• Review and summarize pricing documents based on hospital contracts to calculate expected payments, including Medicaid, percentage of charge, per diems, Medicare IPPS, MSDRG, outlier and/or stoploss, implants, drugs, and other reimbursement models
• Make thorough client observations and recommendations after completing a project audit regarding underpayment exposure, contract risk, and other potential issues
• Work with other account executives and managers to effectively submit bulk listings of accounts to insurance companies for reprocessing (e.g. rebill)
• Escalate accounts to insurance provider relations for resolution and payment, including corresponding appropriately with provider relations teams, tracking progress of issues and ensuring that deadlines are met
• Examine feedback from other internal teams on project activity and provide teams appropriate direction regarding account action when auditing and/or pursuing payments
• Contribute meeting content to team meetings, AC biweekly meetings, and internal project related meetings
• Help create and implement process improvements and trainings to protect future revenue
• Understands and implements best practices for internal processes, communication, and documentation
• Other duties as assigned

Revenue Account Executive

Consultant

• Manage client projects and relationships by participating in meetings, managing action items through to completion, answering client questions, and independently writing client emails
• Compile, QA, and independently manage client processes from start to finish, such as provider relation escalations, bulk issues, regular reports, and invoices
• Manage internal staffing and project needs, including answering questions from other team members on assigned client and monitoring project profitability
• Research and determine next steps for complex and new payer issues and reimbursement areas to uncover potential opportunities, such as reimbursement guidelines and healthcare legislation
• Create and update project plans, including outlining potential risk areas of a hospital-payer contract based on reimbursement structure and how to manually identify within the data
• Review and summarize pricing documents based on hospital contracts to calculate expected payments, including Medicaid, percentage of charge, per diems, Medicare IPPS, MSDRG, outlier and/or stoploss, implants, drugs, and other reimbursement models
• Make thorough client observations and recommendations after completing a project audit regarding underpayment exposure, contract risk, and other potential issues
• Work with other account executives and managers to effectively submit bulk listings of accounts to insurance companies for reprocessing (e.g. rebill)
• Escalate accounts to insurance provider relations for resolution and payment, including corresponding appropriately with provider relations teams, tracking progress of issues and ensuring that deadlines are met
• Examine feedback from other internal teams on project activity and provide teams appropriate direction regarding account action when auditing and/or pursuing payments
• Contribute meeting content to team meetings, AC biweekly meetings, and internal project related meetings
• Help create and implement process improvements and trainings to protect future revenue
• Understands and implements best practices for internal processes, communication, and documentation

Associate Consultant, Zero Balance

• IP Coding Specialists are an important part of the Team at CorroHealth.
• The Coding Team Member will provide CPT, HCPCS and ICD-10-CM coding for 4 or more specialties for one or more clients, facility, or multiple facilities or clients.
• Perform accurate analysis of medical records to obtain necessary information for the appropriate sequencing and assignment of ICD-10-CM and PCS codes.
• Communicate with clients in a professional manner that fosters an excellent working relationship to support the company and its business interests.
• Must maintain quality and productivity standards.

Level 1 Trauma Inpatient Coding Specialist, CCS Required

• Provide various components of coding services to support our clients.
• Validate facility E/M level that is applied by the facility charge ticket.
• Must have experience with coding injections and infusions in the emergency department setting.
• Code surgical procedures typical of an ER setting to capture additional revenue when appropriate.
• Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS.
• Interpret coding guidelines for accurate code assignment.
• Identify the importance of documentation on code assignment and the subsequent reimbursement impact.
• Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and support the Company’s Ethics and Compliance Program.

Emergency Department Coding Specialist

• The Coding Team Member will provide CPT, HCPCS and ICD-10-CM coding a minimum of 1-4 specialties.
• Will be Coding Professional Fee.
• Code surgical procedures typical of an ER setting to capture additional revenue when appropriate.
• Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS
• Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and support the Company’s Ethics and Compliance Program.
• Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information.

Clinic Profee Coding Specialist

Insurance

• Resolve complex, higher-dollar unpaid/denied claims by leveraging proprietary software system, making phone calls, generating letters, accessing client systems and insurance carrier web portals in the pursuit of getting a claim resolved.
• Identify and report trends found during the account resolution process such as CPT/HCPCS errors/deletions, duplicate claims, revenue code mapping mismatches, missing charges, no claim on file.
• Perform financial account assessment functions including but not limited to adjustments and NRP to patient.
• Work within client systems to complete rebill functions.
• Perform administrative functions including but not limited to medical record submissions, billing claims, patient assistance outreach, obtaining documents from client systems and insurance plan code updates, review corrected claim requests and approve for client assistance or correct the bill within client platform, review and submit payment verification assistance requests.
• Maintain familiarity with client preferences and known issues across multiple client accounts.

Acute Hospital Insurance Specialist 3

• Accurately code evaluation and management, lab, radiology, and rehab services
• Work with multiple facility-specific, state billing and coding guidelines
• Communicate account inquiries to clients

Profee Coding Specialist, Ancillary, Rehab, E/M

• Support the overall success of the CDI Staffing Division by managing and assisting the Director and SVP of CDI Services
• Effectively communicates with Director, other Managers, Leads and staff on schedule needs and assignments
• Facilitates initial onboarding process of all concurrent review CDIS to ensure proper understanding of overall workflow process, expectations, and established access
• Reviews the productivity report weekly with each Project Lead; responsible for discussing the CDI’s productivity, monitoring and developing remediation plans for CDIS with Director as needed
• Reviews timecards weekly
• Notifies Director or Assistant Director of CDI Services of errors found, specifically trending by CDIS/Auditor, concerns reported by Project Leads
• Report project status updates to Director weekly and additionally as needed
• Participates in report writing, education development and/or delivery
• Assists in new hire orientation
• Collaborates with CDI Director on Education topics
• Monitors for maintenance of Share Point folders for all staffing projects, discussing needs with Project Leads
• Rounds with each CDI Project lead weekly for updates and needs of individual projects
• Billable 50% per month
• Report work time and work products in a timely and accurate manner
• Communicates with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing
• Interacts with clients in a professional manner, that at all times exhibits excellent relationship, work performance and communication skill so as to support the company and its business interests
• Provide schedule of planned work activities, events and sites and any changes to same, to Management and appropriate coworkers
• Maintenance of professional credentials and knowledge of coding, reimbursement and compliance issues through continuing education
• Periodic travel as required
• Preforms other duties as assigned