CorroHealth

Role Description This is 100% remote. Must reside in the United States. - Performs complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies according to guidelines of the AHA, CMS, AMA, Clinic Coding Clinic and CPT Assistant. - Analyzes audit findings to identify potential root causes of coding errors and prevent their reoccurrence. - Provides second-level review of diagnosis, procedure and billing codes to ensure compliance with legal and procedural policies that ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices. - Research, analyze and respond to inquiries regarding compliance, inappropriate coding, denials and billable services. - Provides technical support and feedback training to internal coding staff regarding coding compliance, documentation, regulatory provisions, third party payer requirements, medical necessity requirements. - Protects the privacy and confidentiality of patient health and client information. - Follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices. - Suggests physician query opportunities based upon documentation and clinical needs. - Prepares deliverables for the coders as required. - Reports work time and work productions in a timely and accurate manner. - Communicates with coworkers in an open and respectful manner which promotes teamwork and knowledge sharing. - Provides schedule of planned work activities, events and sites, and any changes to same to management and appropriate staff. - Maintains professional coding credentials and knowledge of coding, reimbursement methodologies and compliance issues through education. - Monitors the ongoing progress and success of each coder. - Maintains QA percentages within two internal quality goals; 1) overall minimum coder accuracy of 95% and 2) QA review percentages as close to 10% as possible. - Identifies and resolves coding quality problems or issues in a timely manner. - Maintains a continual knowledge of problems or issues that could affect coding quality levels. - Assists in design of systems to help improve coder productivity and assist in improving accuracy of coding. - Provides monthly reports. - Participates in corporate training and meetings. - Provides status reports to senior manager as requested. - Aligns conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and supports the Company’s Ethics and Compliance Program. - Interprets coding guidelines for accurate code assignment. - Identifies the importance of documentation on code assignment and the subsequent reimbursement impact. - Complies with all internal policies and procedures. - Actively participates in Company provided training and education. - Ensures individual compliance with all privacy and security rules and regulations and commits to the protection of all Company confidential information, including but not limited to, Personal Health Information. - ProFee multi-specialty experience required. OP facility experience preferred. Qualifications - Minimum 3 years of Profee coding experience and/or auditing in an acute care facility or multispecialty clinics. - Regular, predictable and punctual attendance is required. - Strong verbal and written communication skills are required. - Ability to prioritize workload, meet deadlines and maintain a high level of quality and accuracy. - Recognized coding credential from AHIMA or AAPC; RHIA or RHIT may also be considered. - Experience with telecommuting and electronic medical records systems strongly preferred. - Strong analytical skills. - Excellent written communication skills. - Strong team player. - Ability to work with multiple and diverse clients and projects. - Ability to work with minimal supervision. - Initiative, resourcefulness and attention to detail. - Customer service support -- minimum one (1) year experience. - Familiarity with hospital outpatient billing processes. - Understand hospital APC assignment and associated coding and documentation. - Coding Certification -- preferred (CPC or CCS). - Strong communication skills, proficient in Microsoft Office applications including Word and Excel. - Ability to navigate in a variety of EMR environments and review hand-written charts. 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 Members must be able to lift and move material weighing up to 20 lbs. Team Members may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.

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. We offer the following products and services: - Denials Management and Complex Claim Resolution - A/R Outsourcing - Patient Access - Revenue Cycle Technology - Consulting Essential Duties and Responsibilities: - Differentiates between clinical and technical denials through EOB’s, denial letters/payer correspondence, and data mining. - Knowledgeable in reviewing UB04 and/or HCFA 1500 Form. - Reviews timely filing guidelines regarding the appeals process. - Contacts payer 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. - 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. Requirements - 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.

Role Description Insurance Specialists are responsible for accurately identifying insurance claims denials and/or claims processing errors to resolve accounts. This is a remote position. - Resolve 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. - Review medical documentation such as UB04 claim forms, EOB’s and medical records to determine the appropriate course of action for claim resolution. - Maintain familiarity with client preferences and known issues. - Meet monthly production and quality expectations. - Comply with HIPAA privacy laws. - Other duties as assigned. Qualifications - High School Diploma or equivalent. - At least one year of physician and/or hospital AR experience preferred. - Knowledge of UB04 claim forms, EOB’s and medical records preferred. - At least one year of Epic, Cerner, Meditech or other EMR experience preferred. - Knowledge of basic computer functions. - Ability to work effectively in a remote environment. - Strong verbal and written communication skills. - Basic mathematics skills (addition, subtraction, calculate percent, etc.). - Ability to analyze and interpret documents, contracts, notes, and other correspondence. - Ability to multitask in a fast-paced environment. - Organization skills with a strong attention to detail. Requirements - 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 Members must be able to lift and move material weighing up to 20 lbs. - Team Members may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.

• Perform denial research and follow-up work with insurance companies via phone to resolve appeals that have been submitted but remain without a determination • Compile multiple documents into appeal bundles and submit appeal bundles to payers in a timely manner • Determine and document appeal timeframes and payer process per facility within CorroHealth proprietary system • Transcribe information from clients’ EMRs and payer portals into required electronic format; check completed work for accuracy • Monitor and complete tasks within shared inboxes and internal request dashboards • Receive and document incoming emails, calls, tickets, or voicemails • Follow up with the client or internal staff via email or phone for additional information as requested • Export and upload documents within CorroHealth proprietary system • Cross-trained on various functions within the department to support other teams as needed • Other responsibilities as requested by management

Role Description The Manager, Payer Strategy & Success will be responsible to ensure customers achieve their Risk Adjustment and Quality Improvement objectives while using Virtix Health’s products and services. As a member of the Payer Strategy & Success Management team, the Manager role will closely partner with Virtix Health’s clients to drive adoption and outcomes leading to renewals, expansion and advocacy across your assigned portfolio. This is a remote position. Essential Duties and Responsibilities - Execute a comprehensive strategic account plan showing current state, target future state with timeline and an underlying plan to drive adoption and outcomes leading to renewals, expansion and advocacy for each customer. - Prepare and lead regular, recurring meetings, to include quarterly business and executive business reviews, demonstrating an understanding of the customer’s goals and effectively communicating the value delivered from Virtix Health’s products and services. - Execute adoption plans to increase utilization and engagement of Virtix Health's products and services. - Proactively identify risks to the customer achieving their stated goals and demonstrate influence in driving outcomes, both internally and externally. - Successfully manage renewal and growth opportunities with each customer, and identify expansion opportunities. - Build and foster senior-level relationships with the customer’s leadership and decision makers to solidify our partnership and commitment to the customer business. - Partner with customer stakeholders to understand their goals, provide guidance and recommendations to help them achieve desired outcomes. - Successfully identify and drive expansion opportunities with assigned customers across Virtix Health's complete portfolio of products and solutions. - Develop and maintain in-depth product knowledge and expertise regarding all Virtix Health’s products, services, and delivery processes, with emphasis on risk adjustment and clinical quality offerings used by Virtix Health’s customers. - Maintain compliance with Virtix Health's policies, procedures and mission statement. - Adhere to all confidentiality and HIPAA requirements as outlined within Virtix Health’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position. - Fulfill those responsibilities and/or duties that may be reasonably provided by Virtix Health for the purpose of achieving operational and financial success of the Company. Requirements - Minimum of 5 years of overall experience, 3 years of customer relationship/account management experience, preferably in healthcare industry. - Ability to communicate with clients effectively regarding all aspects of product, service delivery, and related information. - Demonstrated experience of successfully managing customers, to include renewal and service expansion opportunities. - Aptitude to understand healthcare industry and IT solutions based on analytics. - Problem solving skills and strong communication and interpersonal skills. - A high level of accuracy and attention to detail is required. - Demonstrated ability to capture, understand, manage, and resolve questions and issues. - Ability to manage expectations, create high levels of satisfaction, and effectively convey client needs to internal stakeholders and functions throughout the company. Education - Bachelor’s degree or equivalent experience in a related field is required. Physical Demands and Work Environment - Sedentary work (i.e. sitting for long periods of time). - Subject to inside environmental conditions. - Travel for this position will likely be up to 10%. Benefits - Quality of life with a remote predictable, full-time schedule. - Competitive Salary commensurate to experience. - Annual Bonus Opportunity. - Medical, Dental, Vision coverage and more. - Long-term disability insurance, and life insurance. - Ample parental leave. - 401K with company match. - Certification and Tuition Reimbursement. - Holidays, paid time off.

• Own and manage business analyses, scalability, and driving fresh initiatives for financial planning and business intelligence systems • Collaborate with Finance, Business, and IT Teams to develop initiatives and strategies that optimize costs and improve internal and external reporting • Own and manage multi-departmental initiatives and work with project coordinators and internal teams on progress. Report to management. • Set the prioritization of initiatives based on ROI organizationally and financially • Create detailed business requirements, outlining problems, opportunities, and solutions and have a thorough understanding of key performance indicators • Create requirements for analytics to aid in the creation of actionable dashboards • Conduct ad-hoc analyses. Assemble and summarize data to support operational decision making and develop and/or improve processes and financial reporting. • Resolve complex issues with minimal supervision.

Role Description The Director of Clinical Denials focuses primarily on quality assurance, process improvement, and client health and satisfaction. Ensure production and quality metrics are met for all clients, while ensuring positive staff morale and development. - Work closely with AVP to meet client expectations. - Partner with Managers & Supervisors to ensure that Team Member engagement, performance, and development are top priority. - Partner with Managers & Supervisors to create and document best policies and guidelines for effective performance. - Partner with AVP on client engagement tasks, which include creating and presenting reporting packages. - Ensure production, quality, and effective scores are accurately captured, tracked, and feedback is provided to Team Members in a clear and timely manner. - Oversee that team special projects are executed in a timely and effective manner to ensure quality for client health. - Guide and develop Supervisors in all aspects of Team Member performance management including developing effective action plans, addressing performance challenges in a positive and supportive manner. - Calibrate audit process to ensure quality check is maintained. - Communicate with management on team member performance/improvement opportunities. - Work closely with leadership to ensure best training practices are executed. - Other duties as assigned. Qualifications - At least five years of relevant work experience, including direct people management. - Strong knowledge of the Revenue Cycle Management industry preferred. - Experience managing a remote hourly workforce preferred. - Basic Outlook, Word, and PowerPoint skills (ability to create emails, schedule meetings, and prepare documents and presentations). - Intermediate Excel skills (knowledge of functions such as vlookup, sumif, countif, pivot tables, basic formulas). - Must possess excellent organizational, problem-solving, critical thinking, conflict resolution, and management skills. - Ability to work both independently and with a team. - Ability to actively listen and effectively express ideas verbally and in writing. - Ability to plan, organize, and distribute work assignments. - Ability to train, mentor, lead, motivate, and develop team members. Requirements - 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 Members must be able to lift and move material weighing up to 20 lbs. - Team Members may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.

Role Description The Clinical Review Specialist provides clinical review support on a full-time basis to assist with an increase in inventory and client demand. This role is responsible for reviewing medical records for medical necessity, level of care, authorization compliance, and payer guideline alignment across inpatient and outpatient services. The position supports timely appeal submissions and inventory management while maintaining quality and compliance standards. Essential Duties and Responsibilities - Perform clinical reviews for medical necessity, level of care, and authorization-related denials - Review inpatient and outpatient medical records to support appeal submissions - Apply payer-specific guidelines (CMS, Medicaid, commercial) and internal policies - Identify documentation gaps and support clear, defensible clinical narratives - Meet assigned turnaround times while maintaining quality standards - Document review findings accurately in designated systems - Collaborate with clinical leadership as needed for escalations or complex cases Qualifications - Active, unrestricted RN license (compact preferred) - Minimum 4–5 years of clinical experience - 4+ years of Utilization Review, Appeals, or Clinical Review experience - Strong knowledge of medical necessity criteria and payer guidelines - Experience reviewing inpatient and/or outpatient hospital claims - Proficiency with EMRs and review platforms (Epic preferred) - Strong written clinical documentation and time management skills Preferred Qualifications - Experience with payer appeals (medical necessity, no-auth, readmissions) - Familiarity with InterQual, MCG, or payer-specific criteria - Prior remote clinical review experience - Multi-client or vendor-side experience - Knowledge of Medicare, Medicaid, and commercial payer processes Work Expectations - Remote, independent work with defined productivity expectations Performance Expectations - Timely completion of assigned reviews - Accurate application of clinical criteria and payer policy - Clear, compliant documentation - Ability to adapt to changing inventory and priorities 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.

• 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

• Support the Senior Director in overseeing the Clinical Documentation team's workflow operations • Participate in reviews of organizational and functional activities • Assist in managing a comprehensive and practical schedule of daily production coverage, financial expectations, and client success • Collaborate with the Senior Director to ensure that all client expectations are met to the highest degree of quality • Produce and present reports to leadership to trend and track the success and gaps of the division • Play a role in achieving operational excellence by assisting in the construction of plans and strategies to overcome challenges • Organize, prioritize, and delegate workload within the Clinical Documentation team • Implement Performance Improvement Programs to drive continuous quality and productivity improvements • Identify opportunities for process and product improvements to enhance the department's competitive market position • Participate in cross-functional projects and process improvement initiatives • Facilitate departmental and client meetings, ensuring effective communication and collaboration • Provide timely and accurate reporting regarding department performance, financial goals, and objectives