Remote Clinical Quality Reviewer – Prior Authorization & Coding

CorroHealth Inc; United States; Remote; USD 80,000 - 120,000; Full time

Job summary

CorroHealth Inc is seeking a Remote Clinical Review & Prior Authorization Specialist in the United States. You will perform clinical reviews of PA requests, assess medical necessity, and validate AI-assisted outputs to ensure accurate determinations.

You will collaborate with physicians, coding teams, and QA to maintain CMS turnaround times and compliance. Strong CPT/ICD-10 knowledge and certified coding credentials are preferred.

Qualifications

• Certification through AAPC or AHIMA is preferred.
• Experience reviewing clinical documentation for medical necessity and appropriateness of care.
• Working knowledge of CPT and ICD-10 coding.
• Ability to apply clinical judgment within utilization management workflows.
• Proficiency with healthcare technology platforms and electronic clinical systems.

Responsibilities

• Perform clinical reviews of prior authorization requests for medical necessity and appropriateness.
• Validate AI-assisted review outputs, identify gaps, and escalate deficiencies as needed.
• Review expedited prior authorization and prepayment requests ensuring CMS requirements are met.
• Collaborate with physicians, QA, and coding teams to maintain turnaround times and quality standards.

Skills

AAPC/AHIMA certification

CPT coding

ICD-10 coding

clinical judgment

healthcare IT systems

communication skills

Job description

CorroHealth Inc is seeking a Remote Clinical Review & Prior Authorization Specialist in the United States. You will perform clinical reviews of PA requests, assess medical necessity, and validate AI-assisted outputs to ensure accurate determinations.

You will collaborate with physicians, coding teams, and QA to maintain CMS turnaround times and compliance. Strong CPT/ICD-10 knowledge and certified coding credentials are preferred.