DRG Appeals Clinician, Denials Management Independent Contractor
1 month ago
About CorroHealth:
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.
JOB SUMMARY:
Status – Independent Contractor (Part-Time/Flexible)About CorroHealth: 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.
JOB SUMMARY:
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.Minimum Qualifications & Competencies:
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.Appeal Type Fee
In Patient $ 45/appeal
Out Patient $ 25/appeal
QA Review $ 25/appeal
DRG Downgrade Review $70
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.
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.
We have other current jobs related to this field that you can find below
-
Appeals and Denials Specialist
4 weeks ago
Mount Laurel Township, United States Accuity Full timeJob Type Full-time Description The Appeals and Denials Specialist is responsible for triaging and writing DRG downgrades and clinical validation appeal letters for multiple clients. The Appeals and Denials Specialist will ensure appropriate action is taken within appeal deadlines. This position collaborates with the Appeals...
-
DRG Integrity Specialist
2 months ago
Mount Laurel Township, United States Accuity Full timeJob Type Full-time Description POSITION SUMMARY:As a valued member of the DRG Review Team, the DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and...
-
DRG Integrity Specialist
2 days ago
Mount Laurel Township, United States Accuity Full timeJob Type Full-time Description Accuity was founded in 2016 with the goal of reinventing the Clinical Documentation Process through MD case review, and MD to MD education. Over the last six years, we have experienced rapid growth and are excited to continue in growing our team nationwide. Learn more about us at...
-
Independent Contractor
4 weeks ago
Woodbridge, United States Home Cleaning Squad LLC Full timeJob DescriptionJob DescriptionJob Title: Independent Contractor - Residential CleanerLocation: Prince William County, Stafford, FredericksburgCompany: Home Cleaning SquadJob Type: Full-time, Part-time, ContractPay: $25.00 - $35.00 per hourAbout Us: Home Cleaning Squad is expanding! We are a dynamic and client-focused cleaning service committed to delivering...
-
Plumber Licensed Independent Contractor
2 months ago
Hillsborough Township, United States Ace Handyman Services Remote Work Freelance Full timeAce Handyman Services (www.acehandymanservices.com) is a national home repair and improvement company. We are opening an office in Central Jersey on March 25, 2024. We are currently seeking a skilled Licensed Plumber to join our team as a 1099/independent contractor. The Plumber should have their own transportation, tools and general liability and worker's...
-
Appeals Clerk, Start 7/22
4 weeks ago
Jenkins Township, United States MMC Group LP Full timeJob DescriptionJob DescriptionLocation: Onsite for 3 months during training; afterward, the candidates will be remote.Essential Job Duties:Issue informal resolution based on review of an appeal case by obtaining information from various resources, including utilization of the Income Verification Tool/calculatorAnalyze appeals data using federal and/or state...
-
Appeals Clerk, Start 7/22
4 weeks ago
Jenkins Township, United States MMC Group LP Full timeJob DescriptionJob DescriptionLocation: Onsite for 3 months during training; afterward, the candidates will be remote.Essential Job Duties:Issue informal resolution based on review of an appeal case by obtaining information from various resources, including utilization of the Income Verification Tool/calculatorAnalyze appeals data using federal and/or state...
-
Township of Deptford, United States RNI Enterprise Full time**About us** We are professional, fast-paced, supportive and our goal is to Provide an opportunity for drivers to work consistently and grow with the company. Our work environment includes: - Growth opportunities **Duties**: - Perform route driving to deliver goods and packages to designated locations - Load and unload cargo from the vehicle - Follow...
-
Hair Stylist
3 months ago
Northfield Center Township, United States All About You Salon & Spa Full timeJob DescriptionJob DescriptionCalling all talented independent beauty professionals! At All About You Salon & Suites, we have exciting opportunities for you to create your very own salon space. Take the next step in your career and find the perfect place to service your clients with us.
-
Regional Director Home Delivery
2 weeks ago
Woodbridge Township, United States Transgistics Talent Acquisition Full timeWe have been retained by our client; a large retailer, to find a Director to manage their distribution centers in NY, PA, NJ and CT. The role requires heavy experience with management of home deliveries of large bulky items. Each DC operates independently and requires experience with independent contractors. If you do not have experience managing home...
-
Associate Community Manager
2 weeks ago
Woodbridge, United States Cardinal Management Group Incorporated Full timeJob Description Creating value for our customers is the Cardinal Way. Are you ready to make a difference with a fast-growing team? Then why not join the Cardinal Family, where we strive for Excellence? So what’s the Cardinal way you ask? The Cardinal way of upholding our Values: Accountability Integrity Transparency Essential Function: The role of the...
-
Associate Community Manager
3 weeks ago
Woodbridge, United States Cardinal Management Group Incorporated Full timeJob DescriptionJob DescriptionDescription:Creating value for our customers is the Cardinal Way. Are you ready to make a difference with a fast-growing team? Then why not join the Cardinal Family, where we strive for Excellence?So what’s the Cardinal way you ask? The Cardinal way of upholding our Values:AccountabilityIntegrityTransparencyEssential...
-
Associate Community Manager
2 months ago
Woodbridge, United States Cardinal Management Group Incorporated Full timeJob DescriptionJob DescriptionDescription:Creating value for our customers is the Cardinal Way. Are you ready to make a difference with a fast-growing team? Then why not join the Cardinal Family, where we strive for Excellence?So what’s the Cardinal way you ask? The Cardinal way of upholding our Values:AccountabilityIntegrityTransparencyEssential...
-
ABA Medical Biller
2 weeks ago
Howell Township, United States All About ABA, LLC Full timeJob DescriptionJob DescriptionAll About ABA, LLC is a leading provider of Applied Behavior Analysis (ABA) services for individuals with Autism Spectrum Disorder (ASD). We are currently seeking a highly organized and detail-oriented ABA Medical Biller to join our team. As an ABA Medical Biller, you will play a vital role in ensuring accurate and timely...
-
Nurse Clinician
4 weeks ago
Woodbridge Township, United States Vitalief Inc. Full timeWHY VITALIEF?Vitalief is emerging as an innovative Healthcare consulting company, focused on empowering Research and transforming Clinical Trials to further our mission and our clients’ mission to impact and save lives. As a result, we are seeking a confident and professional Nurse Clinician (RN) for a part-time engagement with one of Vitalief’s premier...
-
Nurse Clinician
1 month ago
Woodbridge Township, United States Vitalief Inc. Full timeWHY VITALIEF?Vitalief is emerging as an innovative Healthcare consulting company, focused on empowering Research and transforming Clinical Trials to further our mission and our clients’ mission to impact and save lives. As a result, we are seeking a confident and professional Nurse Clinician (RN) for a part-time engagement with one of Vitalief’s premier...
-
Physician Medical Billing
7 days ago
Neptune Township, United States YASMESOFT INC Full timeMust have experience working on HFCA 1500 Claims. Should work on A/R Follow up.Medical billing firm is looking to hire AR Follow Up Representatives(Physician Billing) to support their remote workforce. This position will be staffed on a temp to hire basis. The hourly rate of pay is 18.00-20.00 per hour, contingent on prior experience. This is a great...
-
Medical Director
2 months ago
Mount Laurel Township, United States Accuity Full timeJob Type Full-time Description The Medical Director, working together with a coder (DRG Integrity Specialist), will review inpatient charts to ensure the acuity and complexity of the patient's hospital stay is appropriately captured in the clinical documentation and translated into coding. The Medical Director is...
-
Inpatient Coder II
4 weeks ago
Mount Laurel Township, United States Accuity Full timeJob Type Full-time Description POSITION SUMMARY:The Inpatient Coder II is the second level coding position in a 3-tier career ladder. Inpatient Coder IIs will evaluate inpatient medical records and accurately assign the appropriate ICD-10 CM/PCS codes, Present on Admission (POA) indicators, and relevant DRGs. The Coder II...
-
Service Supervisor
2 weeks ago
Woodbridge, United States FCA Management, LLC Full timeJob DescriptionJob DescriptionJob Title: Service SupervisorSupervisor Title: Community ManagerJob Summary:Oversees and performs technical and mechanical work that ensures the inside and external buildings, grounds, amenities, and common areas of the community meet the Company’s standards for cleanliness, appearance, safety, and overall...
