CorroHealth

• Oversee (2) Supervisors and the quality assurance, documentation completeness, regulatory adherence across pre- and post- shipment workflows • Develop and refine workflows to enhance turnaround time, quality assurance, and escalation management • Oversee communications for the Appeals Pre- and Post- Shipment divisions • Serve as the key liaison between Operations, Quality, and Leadership • Partner with senior leadership to identify process improvement opportunities • Analyze root causes of resubmissions, rework, and rejected/returned appeals

• Provide clinical review support on a full-time basis to assist with an increase in inventory and client demand • Review medical records for medical necessity, level of care, authorization compliance, and payer guideline alignment across inpatient and outpatient services • Support timely appeal submissions and inventory management while maintaining quality and compliance standards

• Coding Specialists aid in providing CPT, HCPCS, and ICD-10-CM coding. • Cater to a minimum of 1-4 specialties such as UR, Podiatry, Plastics, Pediatrics, etc. • Code professional fee specialties and facility types. • Ensure compliance with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics. • Actively participate in Company provided training and education.

Role Description CDI Specialists will collaborate extensively with physicians, nursing staff, other patient caregivers, and medical records coding staff to improve the quality, specificity, accuracy, and completeness of the documentation of care provided and coded. CDI Specialist will review medical records for opportunities for diagnosis clarification and validity as it pertains to DRG assignment, severity of illness, risk of mortality, and case mix data as well as timely, accurate, and complete documentation of clinical information used for measuring and reporting physician and facility outcomes. These goals will be accomplished by chart review and query placement when appropriate following AHIMA guidelines and CorroHealth policies and procedures. Essential Duties and Responsibilities - Review outpatient encounters (pre visit, concurrent, and/or post visit) to assess documentation accuracy and completeness. - Identify opportunities for improved documentation related to: - Chronic conditions and disease specificity - Risk adjustment (e.g., HCCs) - Quality measures and medical necessity - Provide compliant documentation clarification via query and feedback to providers through approved communication channels. - Support accurate problem list management and ongoing condition validation. - Collaborate with coding, quality, compliance, and revenue cycle teams as needed. - Track and report CDI interventions, trends, and outcomes. - Participate in provider education and training initiatives. - Stay current on outpatient coding, risk adjustment, and regulatory guidance. - Ensure compliance with CMS, payer, and organizational documentation and billing requirements. - Identify potential compliance risks, including but not limited to overcoding, undercoding, and missing and/or unsupported diagnoses. - Apply knowledge of HCCs, risk adjustment, quality measures, and outpatient reimbursement methodologies as applicable. Qualifications - An active coding credential required such as - RHIA, RHIT, CPC, COC, CCS-O, CCS, CDEO, CCDS, CDIP or CCDS-O. - 3+ years of outpatient coding, risk adjustment, outpatient CDI. - Strong understanding of: - ICD‑10‑CM outpatient coding - Risk adjustment models (e.g., Medicare Advantage HCCs) - Outpatient E/M documentation requirements. - Experience working in an ambulatory EHR (Epic, Cerner, or similar). Skills & Competencies - Strong clinical and analytical judgment. - Professional communication style. - Excellent written documentation skills. - Comfortable working independently in a fast-paced environment. - Proficient in Microsoft Office Applications. Desired Minimum Qualifications - Experience with telecommuting, working with EMRs and other electronic tools. - Strong analytical skills. - Strong Microsoft Office skills. - Works well with numbers. - Strong team player. - Ability to work with multiple and diverse clients and projects. - Ability to work with minimal supervision. - Ability to maintain and access multiple files. - Assure that work product is completed with high levels of accuracy and attention to detail. Education & Experience - CCDS, CDEI, or CDIP certification required. - Current clinical license (RN, NP, PA, MD). - Two years CDI experience. - Two years or more clinical experience in an acute care setting preferred. - Coding professional with CCS or RHIT/RHIA and CDI credential. Minimum three years CDI experience in IP CDI reviews required. Physical Demands Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.

Title: Manager, CDI Services Location: US - Remote time type Full time job requisition id JR104186 About Us: 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. JOB SUMMARY: Job Description Summary The Manager will support the overall success of the CDI Staffing Division by managing and assisting the Director and SVP of CDI Services This is a remote position ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may 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. - 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 - Important Duties and Responsibilities - 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 - Desired Minimum Qualifications - Recognized credential from ACDIS (CCDS) or AHIMA (CDIP). - Experience with telecommuting and electronic medical record systems required. - Current license as a registered nurse (RN) - BSN or MSN preferred - Possess sound judgment and strong analytical skills. - Proficient computer skills, specifically Microsoft Office products. - Proficient skills utilizing a management system. - Strong team player with ability to train and mentor others. - Ability to work with multiple and diverse clients and projects. - Ability to work with minimal supervision. - Ability to maintain and access multiple files. - Assure that work product is completed with high levels of accuracy and attention to detail. - Possess extensive knowledge of medical and health care policies and processes. This is a remote position PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

• Manage AR claim follow up • Review and transmit claims using electronic and manual methods • Review patient bills for accuracy and completeness • Obtain missing information as needed • Identify and bill secondary or tertiary insurances • Correct Medicaid claims via appropriate portal or DDE • Identify opportunities to streamline billing process

Role Description CorroHealth is the partner of choice to healthcare providers in support of their Revenue Cycle challenges. We solve problems through a customized mix of services, consulting and technology that can change over time to meet any client’s evolving needs. We work with 300+ providers in 25+ states and bring a client-focused approach that makes each provider feel like our only client. CorroHealth offers the following products and services: - Denials Management and Complex Claim Resolution - A/R Outsourcing - Patient Access - Revenue Cycle Technology - Consulting The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may 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. - Differentiates between clinical and technical denials through EOB'S, denial letters/payer correspondence and data mining. - Identifies payer and hospital’s managed care contracts. - Reviews managed care contracts against application of rates, provisions and terms. - Reviews timely filing guidelines regarding the appeals process. - Contacts payers to negotiate resolution on technical denials. - Appeals denials using all means necessary (appeal letters, medical records and other supporting documentation, utilization of on-staff clinicians). - Evaluates appeal outcome for next steps (logs recovered funds, supports uphold decision or initiates 2nd level appeal). - Manages assigned workload of accounts through timely follow up and accurate record keeping. Qualifications - Four-year degree preferred or equivalent experience in hospital related billing/follow-up field - Benefits/fund administration experience preferred. - Knowledge of/experience working with managed care contracts. - Experience working with customer support/client issue resolution management. - Strong analytical acumen. - Strong multi-tasking skills. - Proficiency with MS Office. - Excellent oral and written communication skills. Physical Demands Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Role Description 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. Essential Duties and 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. - Pertinent clinical facts include, but are not limited to, documenting 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. Qualifications - 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). - Minimum of 5 years recent acute-care hospital experience, preferred. - Minimum of 2 years Utilization Review / Case Management experience within the last 5 years. - Must have excellent written communication skills and be computer proficient. Physical Demands Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.

• Provide CPT, HCPCS and ICD-10-CM coding across 1-4 specialties • Recognize critical care cases by patient acuity • Code surgical procedures typical of an ER setting • Apply ICD-10-CM diagnosis codes with specificity • Maintain compliance with coding standards and policies • Participate in company training and education sessions • Ensure confidentiality and compliance

• 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 Coding Professional Fee surgeries. • Professional Fee Specialties could include General Surgery, Trauma, and more complex surgeries. • Team Member must be able to work from home and be independent in their coding skills. • Provide various components of coding services to support our clients. • 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.