DRG Appeals Nurse (RN)
CorroHealth · United States · 1 mo ago
RemoteRemoteHealthcareFull-time
We need to output HTML fragment with sections for headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Use for each heading only if there is real specific content. Must not repeat job title. Must not include Job ID etc. Must preserve all substantive info. Remove boilerplate.
We need to parse the posting.
Content:
- About Us: description of purpose, etc. This could be "About the role"? Actually "About Us" is about company. The instruction says use headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we need to map content accordingly.
We have "Job Summary": The DRG Appeals Specialist performs reviews... That's like a summary; could go under About the role? Probably "About the role" heading.
We have "Essential Duties And Responsibilities" and then "Job Responsibilities:" with bullet-like paragraphs. Those are responsibilities.
We have "Must Haves": Current and valid RN license, DRG validation experience, Medical necessity experience and appeal letter writing, Coding certification (AHIMA or AAPC) is a plus. Also "Required Education/Experience": Active RN license in good standing required, CCS preferred after one year of employment, RHIT/RHIA/CPC is a plus, CDIP or CCDS is highly preferred. Professional license (RN) must be maintained. Minimum of 5 years experience in any of the following roles: Inpatient coding quality assurance, DRG validation, DRG appeal, Clinical Documentation Integrity (CDI) as a Clinical Documentation Specialist (CDS), Educator, or Manager.
Then "Skills:" list many skill items.
Then "Benefits": list.
Also "Compensation includes salary plus bonus opportunities" - that's pay info. So we can have Pay section.
Schedule: "Enjoy work-life balance with a predictable schedule" indicates schedule info. Also "This is a remote position" maybe schedule? But schedule is about predictable schedule. We'll include schedule.
We must not create sections with filler like "commensurate with experience". We have actual content.
We must not repeat job title.
We must not include navigation/legal/EEO etc. There's none.
We need to output only HTML fragment, no /, no markdown fences.
We'll produce sections in order: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule.
But we need to decide what goes where.
About the role: Could include Job Summary and About Us description? The About Us is about company, but we can put under About the role maybe. Or we could combine About Us and Job Summary under About the role.
Responsibilities: list of duties from Job Responsibilities and Essential Duties.
Requirements: maybe education/experience requirements (RN license, years experience, etc.) Could be separate from Qualifications? The instruction distinguishes Requirements and Qualifications. Usually Requirements are mandatory, Qualifications are preferred. We'll split: Requirements: Active RN license, minimum 5 years experience in specified roles. Qualifications: CCS preferred, RHIT/RHIA/CPC plus, CDIP/CCDS highly preferred, coding certification (AHIMA/AAPC) plus.
Skills: list of skills.
Benefits: list.
Pay: "Compensation includes salary plus bonus opportunities". Also maybe mention competitive salary from About Us? Actually About Us says "offers outstanding growth opportunities, a competitive salary and flexible work environments." So we can include that.
Schedule: "Enjoy work-life balance with a predictable schedule". Also remote position maybe but schedule is about predictable schedule.
We must not create sections if content is vague like "competitive salary" is specific enough? It's mention of competitive salary, we can include.
We must preserve all substantive information; do not invent or summarize away detail. So we need to keep details like specific software: proprietary denials management application, TruCode, 3M encoder and grouper software, etc. Also mention of continuing education reimbursement, etc.
We must not include boilerplate like "Note: The essential duties and responsibilities below are intended..." That's note; we can drop as it's not substantive? It's meta. Probably drop.
We must not duplicate lines.
Let's extract substantive bullet points.
From Job Responsibilities paragraph:
- Performs comprehensive reviews of inpatient medical records to validate the MS/APR DRGs assigned for Medicare, Commercial, and Third-Party paid claims.
- Validates that all ICD-10-CM/PCS, discharge disposition codes, and Hospital Acquired Condition (HAC), Present on Admission (POA) indicators impacting payment are documented, clinically supported, and assigned following Official Coding Guidelines, compliant query practices and current clinical validation criteria.
- Utilizes audit reference tools and applications (e.g., proprietary denials management application, TruCode, and 3M encoder and grouper software and references).
- Reviews denial letters rationale and formulates custom appeal response letters utilizing strong critical thinking skills to independently access cases for strengths and weaknesses within the appeals spectrum.
- Constructs and documents a brief and fact-based case utilizing compelling clinical evidence from the medical record; supported by current industry clinical guidelines, evidence-based medicine, and official coding guidelines.
- Applies strong writing and grammar skills to formulate professional appeal letters that clearly support each appeal argument.
- Accurately abstracts denial audit findings into our proprietary application in accordance with standard procedures.
- Maintains subject matter expertise in clinical validation criteria and practices, ICD-10-CM/PCS code sets, coding guidelines, clinical documentation integrity, and inpatient payment methodologies.
- Attends continuing education workshops, webinars, etc., for coding and documentation integrity and compliance.
- Other responsibilities as assigned. (maybe drop as generic)
- Duties may be subject to change at any time at the discretion of management... (maybe drop as boilerplate)
From Must Haves:
- Current and valid RN license
- DRG validation experience
- Medical necessity experience and appeal letter writing
- Coding certification (AHIMA or AAPC) is a plus
From Required Education/Experience:
- Active RN license in good standing required
- CCS preferred after one year of employment. (Assistance is available for preparation.)
- RHIT/RHIA/CPC is a plus
- CDIP or CCDS is highly preferred.
- Professional license (RN) must be maintained as a condition of employment.
- A minimum of 5 years of experience in any of the following roles: Inpatient coding quality assurance, DRG validation, DRG appeal, Clinical Documentation Integrity (CDI) as a Clinical Documentation Specialist (CDS), Educator, or Manager.
From Skills list (many). We'll need to preserve each bullet.
Let's extract each skill sentence:
- Extensive Inpatient Coding Skills. Possess regulatory ICD-10-CM/PCS coding expertise coupled with subject matter expertise in MS/APR DRG payment methodologies, including Hospital Acquired Conditions (HACs), POA assignment, and Discharge Disposition codes.
- Clinical Validation Skills. Demonstrate the ability to identify, apply, and validate the use of current industry standard clinical indicators, risk factors and treatment protocols used in clinical validation of payment impacting code assignment.
- Solid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, management and treatment is required.
- Critical Thinking. Actively and skillfully conceptualizes, applies, analyzes, synthesizes, and evaluates information gathered from, or generated by observation, experience, reflection, reasoning, or communication as a guide to validate audit results and correct, as necessary.
- Adaptability. Maintains effectiveness when experiencing changes in work tasks or the work environment; adapts to change in environment and/or circumstances with a positive outlook and adjusts effectively to work within new work structures, processes, requirements, or cultures.
- Initiative. Is proactive and self-directed. Show initiative and responsibility in taking the necessary steps towards problem resolution. Is self-sufficient and does not need to rely on others to complete a job.
- Vivacity. Consistently maintains high levels of activity or productivity sustained over long working hours when necessary; operates with vigor, effectiveness, and determination.
- Performance. Meets or exceeds both production and quality expectations while performing complex medical record audits. Able to execute under pressure of time constraints and while managing multiple responsibilities.
- Planning and Organization. Proactively prioritizes initiatives, effectively manages resources and can multi-task. Actively manages their work assignments and seeks additional tasks when appropriate.
- Communication Skills. Communicates clearly, proactively, and concisely with all key stakeholders. Excellent written and verbal communication skills. Writes clear, compelling, accurate, and concise rationales in support of findings and successfully crafts appeal letters with precise logic.
- Curious and Detailed Oriented. Actively seek out new ideas, possibilities, and answers to the tough questions. Pays meticulous attention to detail, identifies aberrant code assignment, mines medical records for all relevant and supporting evidence, intuitively understands appeal strategies and conscientiously follows all steps in the audit and appeals process.
- Committed to life-long learning.
- PC Skills. Demonstrates proficiency in Microsoft Office and Teams, WebEx, VPN access, navigating various EHRs, and ability to problem solve Internet connectivity issues.
From Benefits:
- Enjoy work-life balance with a predictable schedule
- Compensation includes salary plus bonus opportunities
- Medical, Dental, Vision coverage, 401K
- Holidays, paid time off, short term and long-term disability insurance, and life insurance
- Reimbursement for continuing education and association dues
Also from 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."
Also "CorroHealth is an innovative, rapidly growing organization that provides hospitals with comprehensive solutions focused on the intersection of utilization management, revenue cycle, and compliance. CorroHealth has expanded its product offering to include DRG Revenue Integrity services. CorroHealth provides programmatic solutions for DRG compliance and revenue integrity by leveraging advanced analytics and DRG auditing and clinical expertise. CorroHealth offers outstanding growth opportunities, a competitive salary and flexible work environments. CorroHealth has a vibrant culture that strives to promote a positive work/life balance. Join our team and positively change healthcare!"
We can incorporate some of that into About the role or maybe a separate About Us but we only have headings list; we could put under About the role.
We must not include duplicated lines. Ensure we don't repeat same info.
Now craft HTML.
We'll have:
for each heading only if there is real specific content. Must not repeat job title. Must not include Job ID etc. Must preserve all substantive info. Remove boilerplate.
We need to parse the posting.
Content:
- About Us: description of purpose, etc. This could be "About the role"? Actually "About Us" is about company. The instruction says use headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we need to map content accordingly.
We have "Job Summary": The DRG Appeals Specialist performs reviews... That's like a summary; could go under About the role? Probably "About the role" heading.
We have "Essential Duties And Responsibilities" and then "Job Responsibilities:" with bullet-like paragraphs. Those are responsibilities.
We have "Must Haves": Current and valid RN license, DRG validation experience, Medical necessity experience and appeal letter writing, Coding certification (AHIMA or AAPC) is a plus. Also "Required Education/Experience": Active RN license in good standing required, CCS preferred after one year of employment, RHIT/RHIA/CPC is a plus, CDIP or CCDS is highly preferred. Professional license (RN) must be maintained. Minimum of 5 years experience in any of the following roles: Inpatient coding quality assurance, DRG validation, DRG appeal, Clinical Documentation Integrity (CDI) as a Clinical Documentation Specialist (CDS), Educator, or Manager.
Then "Skills:" list many skill items.
Then "Benefits": list.
Also "Compensation includes salary plus bonus opportunities" - that's pay info. So we can have Pay section.
Schedule: "Enjoy work-life balance with a predictable schedule" indicates schedule info. Also "This is a remote position" maybe schedule? But schedule is about predictable schedule. We'll include schedule.
We must not create sections with filler like "commensurate with experience". We have actual content.
We must not repeat job title.
We must not include navigation/legal/EEO etc. There's none.
We need to output only HTML fragment, no /, no markdown fences.
We'll produce sections in order: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule.
But we need to decide what goes where.
About the role: Could include Job Summary and About Us description? The About Us is about company, but we can put under About the role maybe. Or we could combine About Us and Job Summary under About the role.
Responsibilities: list of duties from Job Responsibilities and Essential Duties.
Requirements: maybe education/experience requirements (RN license, years experience, etc.) Could be separate from Qualifications? The instruction distinguishes Requirements and Qualifications. Usually Requirements are mandatory, Qualifications are preferred. We'll split: Requirements: Active RN license, minimum 5 years experience in specified roles. Qualifications: CCS preferred, RHIT/RHIA/CPC plus, CDIP/CCDS highly preferred, coding certification (AHIMA/AAPC) plus.
Skills: list of skills.
Benefits: list.
Pay: "Compensation includes salary plus bonus opportunities". Also maybe mention competitive salary from About Us? Actually About Us says "offers outstanding growth opportunities, a competitive salary and flexible work environments." So we can include that.
Schedule: "Enjoy work-life balance with a predictable schedule". Also remote position maybe but schedule is about predictable schedule.
We must not create sections if content is vague like "competitive salary" is specific enough? It's mention of competitive salary, we can include.
We must preserve all substantive information; do not invent or summarize away detail. So we need to keep details like specific software: proprietary denials management application, TruCode, 3M encoder and grouper software, etc. Also mention of continuing education reimbursement, etc.
We must not include boilerplate like "Note: The essential duties and responsibilities below are intended..." That's note; we can drop as it's not substantive? It's meta. Probably drop.
We must not duplicate lines.
Let's extract substantive bullet points.
From Job Responsibilities paragraph:
- Performs comprehensive reviews of inpatient medical records to validate the MS/APR DRGs assigned for Medicare, Commercial, and Third-Party paid claims.
- Validates that all ICD-10-CM/PCS, discharge disposition codes, and Hospital Acquired Condition (HAC), Present on Admission (POA) indicators impacting payment are documented, clinically supported, and assigned following Official Coding Guidelines, compliant query practices and current clinical validation criteria.
- Utilizes audit reference tools and applications (e.g., proprietary denials management application, TruCode, and 3M encoder and grouper software and references).
- Reviews denial letters rationale and formulates custom appeal response letters utilizing strong critical thinking skills to independently access cases for strengths and weaknesses within the appeals spectrum.
- Constructs and documents a brief and fact-based case utilizing compelling clinical evidence from the medical record; supported by current industry clinical guidelines, evidence-based medicine, and official coding guidelines.
- Applies strong writing and grammar skills to formulate professional appeal letters that clearly support each appeal argument.
- Accurately abstracts denial audit findings into our proprietary application in accordance with standard procedures.
- Maintains subject matter expertise in clinical validation criteria and practices, ICD-10-CM/PCS code sets, coding guidelines, clinical documentation integrity, and inpatient payment methodologies.
- Attends continuing education workshops, webinars, etc., for coding and documentation integrity and compliance.
- Other responsibilities as assigned. (maybe drop as generic)
- Duties may be subject to change at any time at the discretion of management... (maybe drop as boilerplate)
From Must Haves:
- Current and valid RN license
- DRG validation experience
- Medical necessity experience and appeal letter writing
- Coding certification (AHIMA or AAPC) is a plus
From Required Education/Experience:
- Active RN license in good standing required
- CCS preferred after one year of employment. (Assistance is available for preparation.)
- RHIT/RHIA/CPC is a plus
- CDIP or CCDS is highly preferred.
- Professional license (RN) must be maintained as a condition of employment.
- A minimum of 5 years of experience in any of the following roles: Inpatient coding quality assurance, DRG validation, DRG appeal, Clinical Documentation Integrity (CDI) as a Clinical Documentation Specialist (CDS), Educator, or Manager.
From Skills list (many). We'll need to preserve each bullet.
Let's extract each skill sentence:
- Extensive Inpatient Coding Skills. Possess regulatory ICD-10-CM/PCS coding expertise coupled with subject matter expertise in MS/APR DRG payment methodologies, including Hospital Acquired Conditions (HACs), POA assignment, and Discharge Disposition codes.
- Clinical Validation Skills. Demonstrate the ability to identify, apply, and validate the use of current industry standard clinical indicators, risk factors and treatment protocols used in clinical validation of payment impacting code assignment.
- Solid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, management and treatment is required.
- Critical Thinking. Actively and skillfully conceptualizes, applies, analyzes, synthesizes, and evaluates information gathered from, or generated by observation, experience, reflection, reasoning, or communication as a guide to validate audit results and correct, as necessary.
- Adaptability. Maintains effectiveness when experiencing changes in work tasks or the work environment; adapts to change in environment and/or circumstances with a positive outlook and adjusts effectively to work within new work structures, processes, requirements, or cultures.
- Initiative. Is proactive and self-directed. Show initiative and responsibility in taking the necessary steps towards problem resolution. Is self-sufficient and does not need to rely on others to complete a job.
- Vivacity. Consistently maintains high levels of activity or productivity sustained over long working hours when necessary; operates with vigor, effectiveness, and determination.
- Performance. Meets or exceeds both production and quality expectations while performing complex medical record audits. Able to execute under pressure of time constraints and while managing multiple responsibilities.
- Planning and Organization. Proactively prioritizes initiatives, effectively manages resources and can multi-task. Actively manages their work assignments and seeks additional tasks when appropriate.
- Communication Skills. Communicates clearly, proactively, and concisely with all key stakeholders. Excellent written and verbal communication skills. Writes clear, compelling, accurate, and concise rationales in support of findings and successfully crafts appeal letters with precise logic.
- Curious and Detailed Oriented. Actively seek out new ideas, possibilities, and answers to the tough questions. Pays meticulous attention to detail, identifies aberrant code assignment, mines medical records for all relevant and supporting evidence, intuitively understands appeal strategies and conscientiously follows all steps in the audit and appeals process.
- Committed to life-long learning.
- PC Skills. Demonstrates proficiency in Microsoft Office and Teams, WebEx, VPN access, navigating various EHRs, and ability to problem solve Internet connectivity issues.
From Benefits:
- Enjoy work-life balance with a predictable schedule
- Compensation includes salary plus bonus opportunities
- Medical, Dental, Vision coverage, 401K
- Holidays, paid time off, short term and long-term disability insurance, and life insurance
- Reimbursement for continuing education and association dues
Also from 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."
Also "CorroHealth is an innovative, rapidly growing organization that provides hospitals with comprehensive solutions focused on the intersection of utilization management, revenue cycle, and compliance. CorroHealth has expanded its product offering to include DRG Revenue Integrity services. CorroHealth provides programmatic solutions for DRG compliance and revenue integrity by leveraging advanced analytics and DRG auditing and clinical expertise. CorroHealth offers outstanding growth opportunities, a competitive salary and flexible work environments. CorroHealth has a vibrant culture that strives to promote a positive work/life balance. Join our team and positively change healthcare!"
We can incorporate some of that into About the role or maybe a separate About Us but we only have headings list; we could put under About the role.
We must not include duplicated lines. Ensure we don't repeat same info.
Now craft HTML.
We'll have:
About the role
Job Summary: The DRG Appeals Specialist performs reviews of inpatient DRG payer denials on behalf of hospital client partners, including reviewing denial letters, determining and entering audit recommendations, and preparing professional appeal responses submitted timely under payer timeframes.
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. CorroHealth is an innovative, rapidly growing organization that provides hospitals with comprehensive solutions focused on the intersection of utilization management, revenue cycle, and compliance. CorroHealth has expanded its product offering to include DRG Revenue Integrity services. CorroHealth provides programmatic solutions for DRG compliance and revenue integrity by leveraging advanced analytics and DRG auditing and clinical expertise. CorroHealth offers outstanding growth opportunities, a competitive salary and flexible work environments. CorroHealth has a vibrant culture that strives to promote a positive work/life balance. Join our team and positively change healthcare!
But we need to avoid repeating content; maybe combine. Better: About the role: include Job Summary and maybe a brief about company. We'll keep it concise but preserve all info. However we must preserve ALL substantive information; cannot omit any detail. That