Remote Clinical Quality Reviewer: Prior Authorization

CorroHealth Inc; Town of Texas (WI); Remote; USD 65,000 - 90,000; Full time

Job summary

CorroHealth Inc. seeks a remote Clinical Reviewer to support the WISeR Prior Authorization Program across the US. You will perform clinical reviews, validate documentation, and support physician determinations in CMS-aligned workflows.

The role emphasizes accuracy, regulatory compliance, and collaboration with physicians, nurses, quality teams, and technology partners in a 24/7 review environment.

Qualifications

• Certification through AAPC or AHIMA preferred.
• Experience reviewing clinical documentation for medical necessity.
• Knowledge of CPT and ICD-10 coding.
• Ability to apply clinical judgment in utilization management.
• Proficiency with healthcare technology platforms and EHRs.
• Strong analytical, written, and verbal communication skills.
• Coding or auditing credential from AAPC or AHIMA.

Responsibilities

• Perform clinical reviews of prior authorization requests per CMS, WISeR, and internal policies.
• Participate in quality assurance to ensure accuracy and regulatory compliance.
• Review CPT/ICD-10 coding and align documentation with authorizations.
• Support workload prioritization and expedited case handling.
• Provide structured clinical feedback to improve AI-assisted review outputs.

Skills

Clinical review

CMS guidelines

Analytical skills

Written communication

Verbal communication

Clinical judgment

AI-assisted feedback

Education

AAPC/AHIMA certification

Tools

EHR systems

AI-assisted review tools

Job description

CorroHealth Inc. seeks a remote Clinical Reviewer to support the WISeR Prior Authorization Program across the US. You will perform clinical reviews, validate documentation, and support physician determinations in CMS-aligned workflows.

The role emphasizes accuracy, regulatory compliance, and collaboration with physicians, nurses, quality teams, and technology partners in a 24/7 review environment.