CorroHealth

Insurance

• Review and resolution of outstanding insurance balances on hospital or physician patient accounts
• Manage assigned insurance receivables to achieve business line expectations
• Meet productivity standards as outlined by business line
• Achieve minimum work quality scoring and accuracy on all accounts worked
• Complete timely follow-up on assigned accounts
• Ensure cash recovery goals are met
• Ensure insurance accounts are resolved within 90 days of placement
• Document actions taken and next steps for account resolution
• Prepare appeals for payment to insurance company when appropriate
• Maintain high quality account handling per client standards
• Comply with all federal and state rules and regulations governing phone calls and collections including HIPAA, FDCPA, Privacy Act, FCRA

Insurance Specialist – Level 2

Manager

• The Manager of Clinician Appeals is responsible for the strategic oversight and operational execution of the appeals letter writing and client education engagement.
• Lead high-performing clinical teams in the development of clinically accurate, persuasive, and compliant appeal communications to payers.
• Ensure operational excellence, clinical integrity, and alignment with financial goals.
• Work closely with internal leadership, administrative operations, and external clients to ensure best-in-class service delivery in a dynamic revenue cycle environment.
• Build, lead, and scale the clinical letter writing team, ensuring appropriate staffing levels.
• Finalize training programs and establish QA standards for the team.
• Develop and continuously improve robust QA programs.

Manager, Appeals Management

Administration

• Report directly to the Senior Director of Clinical Documentation
• Assist the Senior Director in overseeing the Clinical Documentation team's workflow operations
• Manage a comprehensive and practical schedule of daily production coverage, financial expectations, and client success
• Ensure that all client expectations are met to the highest degree of quality
• Produce and present reports to the Clinical Documentation team and other leadership members
• Collaborate with the Clinical Documentation team to achieve operational excellence
• Organize, prioritize, and delegate workload within the Clinical Documentation team
• Implement Performance Improvement Programs to drive continuous quality and productivity improvements
• Assist in the preparation and documentation of policies and procedures
• Identify opportunities for process and product improvements
• Participate in cross-functional projects and process improvement initiatives
• Facilitate departmental and client meetings for effective communication
• Produce and facilitate monthly or quarterly executive report outs to clients
• Provide timely and accurate reporting regarding department performance, financial goals, and objectives

Administrator, CDI Services

General

• Manage the Authorization process end to end, from initial notification, entry and submission of required information, follow up all the way to determination and discharge.
• Maintain detailed documentation of the record in the EMR system, in the internal CorroHealth system and in the Health Payer portals.
• Verify correct eligibility and benefits for patients.
• Act as a liaison between the hospital staff and the Health Payer to facilitate information sharing and successful process completion within allocated timeframe.
• Review timely filing guidelines regarding the utilization management process.
• Track and follow up with payers on pending authorizations to ensure timely responses.
• Contact payer to elicit further information regarding status, decisions and remove hurdles in the processing.
• Identify and escalate issues that may result in delays or denials.
• Manage assigned workload of accounts through timely follow up and accurate record keeping.
• Maintain compliance with HIPAA and other healthcare regulations.

Coordinator, Utilization Management

Medical Billing and Coding

• Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product.
• Use software to develop standardized reports, meet with clients, respond to coding questions in clear, concise, grammatically correct English, and provide support for other members of the revenue cycle consulting team.
• Client education, written FAQ answer preparation, and other duties as assigned.
• Become proficient in the use of the PARA Data Editor, our proprietary software; select and review claims for review based on trends/data analysis in the PARA Data Editor; organize information and access to medical documentation.
• Audit all aspects of claim including (but not limited to): -Omitted or incorrect charges, -Review OPPS and CAH charges and apply guidelines.
• CMS/Payer specific guidelines -Coding accuracy for ICD-10 CM, CPT/HCPCS (including but not limited to 10000-69999, 80000, 90000, J codes, G codes, Q codes,etc).
• Departmental review for inaccuracies, omitted data/documentation and charges -NCCI edits, MUE edits, Medi-cal and Medicare guidelines/CMS Manual guidance, -Units of services -E/M Profee/Facility -Units of services -Documentation improvement.
• Assist in preparing written documents for publication under the direction of the Director, HIM, i.e., Q&A entries.
• Develop a working understanding of the outpatient hospital reimbursement process, including documentation, coding, and billing.
• Participate in presentations to clients and prospective clients, typically over web meetings.
• Develop and maintain the skills and knowledge necessary related to the assigned specialty areas and the related services.

Claim Review Specialist – Coding Certification Required

• The Manager of Clinician Appeals is a clinical leader responsible for the strategic oversight and operational execution of the appeals letter writing and client education engagement.
• Lead high-performing clinical teams in the development of clinically accurate, persuasive, and compliant appeal communications to payers.
• Ensure operational excellence, clinical integrity, and alignment with financial goals.
• Work closely with internal leadership, administrative operations, and external clients to ensure best-in-class service delivery.
• Manage and develop both domestic and global clinicians who write appeal letters including interviewing candidates, supporting onboarding, and serving as a subject matter expert.

Manager, Clinician Appeals – Some Travel Required

Executive

• Perform all or most of the primary duties listed below
• Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member

Senior Executive – HIM Services

• Serves in a trainee capacity, receiving formal and on-the-job training to assist patients navigate through the healthcare system
• Responsible for reviewing and processing all incoming and outgoing referrals
• Tracking referral status and ensuring timely follow up
• Complete patient registration by obtain and verify health plan coverage
• Maintain quality scoring and accuracy on all accounts worked

Patient Services Representative

Analyst

• The Revenue Analyst role consists of thorough and extensive analyzation and investigative assessment of claims that have been identified as paid incorrectly.
• Through phone and written correspondence with insurance companies, the Revenue Analyst initiates pursuit of incorrectly paid medical insurance claims.
• Independently, consider business needs and adjust workflow accordingly when reviewing and researching available accounts for potential payer underpayments to pursue.
• Analyze and ascertain pertinent information from multiple sources (e.g., hospital systems, medical records, claims) to identify true causality for underpayments.
• Recognize payor and client trends and perform research to maximize profitability.
• Consider account profitability and cost analysis when reviewing for potential rebills.
• Analyze payer contracts for revenue risks when business needs arise.
• Facilitate and communicate results of rebills with auditors.
• Mentor and assist with onboarding of incoming Revenue Analysts.
• Coordinate and lead training for incoming team members.
• Facilitate and or annotate internal team meetings.
• Collaborate with manager and project leads to perform client work as assigned.
• Manage multiple internal projects while adhering to deadlines and weekly goals.
• Other duties as assigned.

Revenue Analyst 2, Zero Balance

Auditor

• Perform Diagnostic Related Group (DRG) validation and quality audits on Inpatient charts.
• Perform chart reviews and ensure all reviewed charts capture the patient’s true clinical picture.
• Validate proper sequencing and accuracy of ICD-10-CM/PCS codes.
• Maintain quality of reviews, ensuring true clinical picture is captured timely.
• Support CorroHealth in developing accurate training materials.
• Provide training and shadowing to new hires.
• Assist CorroHealth with project data analysis, reporting, and feedback.

DRG Revenue Integrity Auditor

• Provide various components of coding services to support our clients.
• Provider rounding E/M coding.
• 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.
• Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information.

Hospitalist Profee Coding Specialist

• Coding Professional Fee Inpatient Cardiology
• Calculate ProFee E/M levels by using an algorithm created by the company
• Recognize critical care cases by patient acuity
• Code CPT for procedures performed in the office setting or bedside procedures performed in the hospital setting
• Ensure accurate application of ICD-10-CM diagnosis codes
• 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
• Comply with all internal policies and procedures
• Participate in Company provided training and education

Inpatient Cardiology Coder, E/M & OBS

• Coding Specialists are an important part of the Team at CorroHealth.
• The Coding Team Member will provide CPT, HCPCS and ICD-10-CM coding a minimum of 1-4 specialties.
• Will be Outpatient Clinic Visits in various specialties including but not limited to Cardiology, Sleep Studies, Endocrinology and GI.
• 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.

Clinic Coding Specialist

Consultant

• Serves in a consulting role by evaluating the work of client’s coders in their assignment of ICD-10, CPT and/or HCPCS codes to hospital inpatient, outpatient and/or physician practice encounters.
• Performs concurrent or retrospective reviews to inventory code assignments and report the data to the client.
• Develops and delivers educational content to clients related to audit findings.
• Validate coded data as recognized by the AHA, CMS, AMA, AHIMA, AAPC, Coding Clinic, and CPT Assistant within the professional fee billing model.
• Analyze findings and identify potential root causes of produced errors.
• Prepare summary reports of findings to clients, supplying specific references supporting findings contained within the provided audit report.
• Provides second-level review of processes to ensure compliance with legal and procedural policies and to ensure appropriate code assignments.
• Research, analyze, and respond to inquiries regarding compliance, coding, and denials.
• Functions as a member of the Consulting Services Team which develop and provide coding education to clients.
• Conduct Audits as assigned meeting the productivity standards as set by record type for each audit.
• Prepare deliverables for the client as required for the audit scope while meeting timelines.
• Conduct independent QA of their assigned audit results prior to final submission for QA review and approval.
• 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.
• Interact with clients in a professional manner that exhibits excellent relationships, work performance and communication skills 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 staff.
• Maintenance of professional credentials and knowledge of coding, reimbursement, and compliance issues through continuing education.

Auditing & Education Consultant – Professional Fee

• The Manager of Clinician Appeals is responsible for the strategic oversight and operational execution of the appeals letter writing and client education engagement.
• Lead high-performing clinical teams in the development of clinically accurate, persuasive, and compliant appeal communications to payers.
• Ensure operational excellence, clinical integrity, and alignment with financial goals.
• Work closely with internal leadership, administrative operations, and external clients to ensure best-in-class service delivery.
• Build, lead, and scale the clinical letter writing team, ensuring appropriate staffing levels aligned to current and forecasted client demand.
• Oversee hiring, onboarding, training, and performance management of clinical writers.
• Define and implement the team’s leadership structure and workflows. Enforce quality and productivity standards.
• Develop and continuously improve robust QA programs ensuring appeal content meets or exceeds clinical accuracy, appropriateness, and grammatical standards.
• Understand the appeals financial model and associated KPIs; align clinical operations to meet or exceed revenue and margin targets.
• Identify and champion process improvement and efficiency initiatives to increase clinical team productivity without compromising quality.