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R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. Here's what you'll experience working as our Surgical Coding Supervisor: <ul> <li>Responsible for the daily operations of Coding functions including assigning daily work and ensuring appropriate workflow.</li> <li>Meet routine deadlines and work schedules as well as timely and accurate completion of special projects and any other duties as assigned</li> <li>Coach and mentor, all employees to improve work processes to reduce or eliminate non-compliance</li> <li>Completed performance evaluations for staff in a timely manner, including initial and 90-day competencies, and annual performance evaluations</li> <li>Display a positive attitude as well as professional, polite, considerate, and courteous conduct and treatment of others in the course of duties</li> <li>Participates in Performance Improvement activities</li> <li>Establish working relationship with on and offshore counterparts; serve as a liaison between hourly and management staff for training, quality, and general questions.</li> <li>Participate in weekly operations meetings to drive performance excellence. Troubleshoot and resolve issues with client concerns with a sense of urgency.</li> </ul>Required Qualifications:<ul> <li>2 years of Coding experience.</li> <li>2 years of Surgical Coding experience.</li> <li>Excellent verbal and written communication skills.</li> <li>Personal drive and focus on measurable goals.</li> <li>Excellent analytical skills.</li> <li>Professional demeanor.</li> <li>Resourceful, task-oriented, and willing to challenge the norm.</li> <li>Excellent people skills.</li> </ul>Desired Qualifications:<ul><li>2 years coding leadership experience preferred</li></ul>For this US-based position, the base pay range is $43,888.00 - $70,631.44 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.This job is eligible to participate in our annual bonus plan at a target of 5.00%The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a <a href="http://go.r1rcm.com/benefits" target="_blank">competitive benefits package.</a>R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights <a href="https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf" target="_blank">California Consent </a>To learn more, visit: <a href="https://R1RCM.com" target="_blank">R1RCM.com</a>Visit us on <a href="https://www.facebook.com/R1RCM" target="_blank">Facebook</a>

R1 RCM

Surgical Coding Supervisor

The Professional Services Coder will be responsible for reviewing clinical documentation and diagnostic results as appropriate (i.e., to extract data and apply appropriate ICD-10-CM, HCPCS and CPT-4 codes for billing, review and correct billing edits, internal and external reporting, research, and regulatory compliance). Under the direction of the Coding Leadership Team, the successful candidate must be able to accurately code conditions and procedures as documented in the ICD-10-CM Official Guidelines for Coding and Reporting. Responsibilities: • Assigns codes for diagnoses, treatments and procedures according to the appropriate classification system for professional service encounters to determine the highest level of specificity ICD-10 codes, CPT codes, HCPCS codes, and modifiers. • Reviews physician assigned diagnosis code after thorough review of the medical record and, if necessary, queries physician for additional clarity in a professional manner. • Able to accurately abstract information from the medial records into the abstract system, according to established guidelines. • Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC) adheres to official coding guidelines • Enters and validates codes, charges and other edits flagged in Athena or EPIC for review. • Review documentation (and returned accounts) to verify and correct place of service, billing and service providers, or other missing data elements (ie: NDC #, or number of units) • Uses CCI edit software to check bundling issues, modifier appropriateness, and LCD’s/NCD’s for medical necessity. • Communication with other departments to recommend coding guidance for charge corrections, appeals processes, and patient billing concerns. • Meet and/or exceeds the established coding productivity standards • Meet and/or exceeds the established quality standard of 95% accuracy while meeting and/or exceeding productivity standardsRequired Qualifications: • High School Diploma or GED required CCS-P, CPC• Five (5) + years in Cardiology coding• Surgical coding experience• Adaptability • Must be able to demonstrate proficiency in professional services (95% accuracy). • Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA) (ie: Documentation Guidelines ’95 &amp; ’97) • Extensive knowledge of government, and commercial payer guidelines. • Must be able to use standard office equipment and information systems. • Ability to interact with other employees through effective communication. • Ability to prioritize and shift workloads to ensure departmental goals align with revenue cycle goals Desired Qualifications:• Experience in coding other specialties such as neuro, thoracic, podiatry, GI etc• Experience using EPICFor this US-based position, the base pay range is $18.16 - $31.13 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a <a href="http://go.r1rcm.com/benefits" target="_blank">competitive benefits package.</a>R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights <a href="https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf" target="_blank">California Consent </a>To learn more, visit: <a href="https://R1RCM.com" target="_blank">R1RCM.com</a>Visit us on <a href="https://www.facebook.com/R1RCM" target="_blank">Facebook</a>

Cardiology Coding Associate III

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. **We are currently hiring for 8 Financial Counseling roles, all REMOTE with varying shifts.** Bilingual candidates will be prioritized! The Financial Counselor will be responsible for counseling patients or parties responsible for payment. The Patient Financial Counselor will educate patients on their responsibilities and potential options. The PFC is responsible for accurately and compassionately explaining to the patient their financial obligations during the financial counseling session. In addition, the counselor must obtain any necessary pre-certifications or authorizations and assist with any financing or third-party applications. In this role, the successful candidate must display a strong sense of patient care and attention to detail. Here’s what you will experience working as a Financial Counselor: <ul> <li>Explain financial responsibilities for services received payment options and collection procedures to patients or parties responsible for payment. </li> <li>Counsel patients regarding insurance benefits and recommend alternative sources of payment and financial assistance when appropriate. </li> <li>Contact insurance carriers or other sources and act as an advocate for the patient. </li> <li>Initiate process for collecting prepays due and perform follow up activity to insure maximum collection is achieved. </li> <li>Identify hospital, public and private financial assistance programs for patients unable to meet their financial obligations. </li> <li>Work with Case Management, Clinical Staff, Medicaid Vendor, and Family Independence Agency to assist patients and families in completing assistance program applications and determine eligibility and coverage. </li> <li>Notify manager, physician and servicing department of possible delay of service for any elective, urgent admissions, procedures and scheduled diagnostic testing which have not been approved prior to the date of service. </li> <li>Maintain accurate documentation of pre-processing information. </li> <li>Provide assistance to uninsured patients and families in completing and filing Medicaid or assistance program applications with the appropriate agency. </li> <li>Perform all other duties and projects as assigned. </li> </ul>Required Skills: <ul> <li>High school diploma is required </li> <li>At least one year of call center experience </li> <li>Attention to detail </li> <li>Strong customer service experience </li> <li>Ability to multi-task and navigate between multiple systems simultaneously </li> <li>Ability to handle a large volume of incoming calls </li> </ul>For this US-based position, the base pay range is $17.25 - $24.73 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a <a href="http://go.r1rcm.com/benefits" target="_blank">competitive benefits package.</a>R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights <a href="https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf" target="_blank">California Consent </a>To learn more, visit: <a href="https://R1RCM.com" target="_blank">R1RCM.com</a>Visit us on <a href="https://www.facebook.com/R1RCM" target="_blank">Facebook</a>#tj2022 #healthcare #customerservice #financialcounseling #banking #LI-TJ2022 #REMOTE

Financial Counseling Representative I Bilingual

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our Staff DataOps Engineer, you will focus on being a technical leader, engineering and delivering high-quality solutions in healthcare revenue cycle management (RCM). Every day, you will be responsible for proactively collaborating within the team, as well as across teams, stakeholders and product managers to communicate effectively, understand priorities and deliver engineered solutions. To thrive in this role, you must be a good communicator with a proactive sense of engagement and provide technical leadership.Here’s what you will experience working as Staff DataOps Engineer: <ul> <li>Engage in the full software development lifecycle, from design to deployment, participating in 2-week sprint development cycle </li> <li>Use Agile methodologies to design, develop and maintain solutions, ensuring engineering (software &amp; data) and operational excellence</li> <li>Engineer, deploy and operate high-quality solutions in healthcare revenue cycle management (RCM) </li> <li>Collaborate across teams, stakeholders, and product managers to communicate effectively, understand priority and deliver engineered solutions</li> <li>Actively participate in team iterating on team processes and practices </li> <li>Make code quality, code practice and architectural suggestions to the team</li> <li>Anticipate future technical opportunities and problems and collaborate to address them</li> </ul>To be successful in this role, the candidate will have:<ul> <li>Expert knowledge in Scala and Spark</li> <li>Ability to refactor large, complex notebooks into clean, testable software</li> <li>Significant experience with Azure Databricks, including Workflow tuning for performance and cost optimization</li> <li>Expertise in NoSQL and relational databases like Cosmos DB, MongoDB, and SQL Server</li> <li>Experience with Azure (preferred) or AWS</li> <li>Experience with Infrastructure as Code (Terraform, Bicep, ARM templates)</li> </ul>It's a plus if you bring:<ul> <li>Bachelor’s degree in computer science, IT, or systems engineering or equivalent work experience</li> <li>Experience in developing healthcare applications</li> <li>Experience in Al/ML, LLMs, RAG architectures, etc.</li> </ul>For this US-based position, the base pay range is $140,000.00 - $194,785.02 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.This job is eligible to participate in our annual bonus plan at a target of 10.00%The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a <a href="http://go.r1rcm.com/benefits" target="_blank">competitive benefits package.</a>R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights <a href="https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf" target="_blank">California Consent </a>To learn more, visit: <a href="https://R1RCM.com" target="_blank">R1RCM.com</a>Visit us on <a href="https://www.facebook.com/R1RCM" target="_blank">Facebook</a>

Staff Software Engineer

R1 RCM Inc. is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals and physician practices. Headquartered in Chicago, R1® is a privately held organization with employees throughout the US and international locations. Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience. DescriptionThe RVP of Sales is a commercial role primarily responsible for driving revenue growth through new client acquisition and expansion sales of R1’s Revenue Performance Solutions. This role is assigned to a region with a specific number of viable accounts and related opportunities. As RVP of Sales, the role will focus on engaging and penetrating net new Tier 1 and 2 target accounts (i.e., high-value prospects) while also growing R1’s business via existing clients. In addition to his/her own prospecting and networking initiatives, the RVP will partner with R1’s Revenue Performance Solutions Business Development team of in-house and outsourced lead generation professionals to build an active sales funnel (i.e., sales staged Qualified and above) with booking values equal to or greater than 2.5x his/her assigned sales quota in estimated first year revenue to R1. RVP of Business Development:<ul> <li>Develop and execute a strategy that aligns with company objectives to rapidly build brand awareness and drive new revenue within the assigned geography</li> <li>Meet or exceed monthly, quarterly and annual goals</li> <li>Accurately forecast attainment on a monthly, quarterly and annual basis</li> <li>Document sales activity through CRM automation tool (Salesforce)</li> <li>Assess areas of personal and professional development, which would enable greater individual, as well as team, sales success</li> <li>Possess a strong/effective presence with hospital and health systems' various leadership teams and executives, including the C-suite; Ability to navigate, coordinate and influence internal and external customers at all levels of the organization</li> <li>Demonstrated ability to collaborate in a team selling environment, to identify, pursue and capture new client relationships. </li> </ul>REQUIRED QUALIFICATIONS<ul> <li>Minimum of 5 years of proven success selling Healthcare professional services within the areas of finance, patient accounting, HIM or revenue cycle to provider organizations</li> <li>2+ years of account management, client success management, and/or revenue cycle operations consulting experience working with Vice President and Director-level partners</li> <li>Healthcare experience working with acute care provider organizations</li> <li>Proficiency with Microsoft Office, including basic to intermediate Excel functions, and CRM application use (Salesforce)</li> <li>Ability to travel up to 50%</li> </ul>For this US-based position, the base pay range is $116,133.00 - $173,605.10 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a <a href="http://go.r1rcm.com/benefits" target="_blank">competitive benefits package.</a>R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights <a href="https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf" target="_blank">California Consent </a>To learn more, visit: <a href="https://R1RCM.com" target="_blank">R1RCM.com</a>Visit us on <a href="https://www.facebook.com/R1RCM" target="_blank">Facebook</a>

Regional Vice President Sales-Southwest

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As Analytics Services Manager on our Physician Business Analytics Team, you will be pivotal in bridging the gap between business stakeholders and our development team. Every day you will be gathering reporting requirements, creating development stories, and working closely with developers to scope and groom development backlogs. To thrive in this role, you must make strategic trade-off decisions between scope and schedule while maintaining a strong focus on outcomes. You will collaborate daily with business managers, operational end users, as well as product engineering and development partners to clearly define reporting requirements, business priorities, enhancement requests, acceptance criteria, and deployment timelines. Here’s what you will experience working as an Analytics Services Manager: <ul><li>Interact with operational leaders, client managers, end users, and engineering teams to convey requirements, analytics use case vision, business priorities, enhancement requests, acceptance criteria, and deployment timelines. </li></ul> <ul><li>Create and manage development stories, ensuring they are well-defined and prioritized. Collaborate with developers to scope and groom backlogs, maintaining a steady pipeline of high-value work. </li></ul> <ul><li>Coordinate the development process, ensuring alignment across development, QA, and business acceptance. Track sprint progress and communicate outcomes effectively to stakeholders. </li></ul> <ul><li>Support the development of custom analytics capabilities, data extracts, and report visualizations. Guide the release and integration of custom analytics requests with enterprise analytics product and client teams. </li></ul> <ul><li>Oversee the quality assurance process, ensuring thorough developer acceptance testing to maintain high standards of data and report quality. </li></ul> Required Skills: <ul><li>Proven experience in analytics, product management or a similar role. </li></ul> <ul><li>Strong analytical and problem-solving skills, with the ability to translate complex business needs into actionable development stories. </li></ul> <ul><li>Excellent communication and interpersonal skills. </li></ul> <ul><li>Experience with agile methodologies and tools. </li></ul> <ul><li>Ability to manage multiple projects simultaneously. </li></ul> <ul><li>Self-driven, diligent, and exhibits an aptitude for solving problems. </li></ul> <ul><li>Strong organizational skills, including the ability to plot a path towards delivering outcomes that drive value for the business. </li></ul> <ul><li>Experience interfacing directly with technology leaders and engineers, collaborating on enhancement requests and acceptance criteria </li></ul> For this US-based position, the base pay range is $47,237.00 - $78,919.86 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.This job is eligible to participate in our annual bonus plan at a target of 5.00%The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a <a href="http://go.r1rcm.com/benefits" target="_blank">competitive benefits package.</a>R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights <a href="https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf" target="_blank">California Consent </a>To learn more, visit: <a href="https://R1RCM.com" target="_blank">R1RCM.com</a>Visit us on <a href="https://www.facebook.com/R1RCM" target="_blank">Facebook</a>

Analytics Services Manager

Location: Remote, USShift: Flexed weekday daytime schedule with some weekend and evening requirements throughout the month.R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our Utilization Review Author, you will help our hospital clients by working alongside our Physician Advisory team to provide first-level initial admission and continued stay case reviews. Every day you will, determine the appropriate cases for review, utilizing client-specific guidelines. Upon identification of a case, you will ensure that appropriate orders and clinical documentation are in place prior to the application of the evidence-based criteria. To thrive in this role, you must have experience in a clinical inpatient environment and hospital-based utilization or case management experience. Proficiency in basic computer skills is essential for excelling in this remote position.Here’s what you will experience working as a Utilization Review Author:<ul> <li>Perform initial admission and continued stay reviews utilizing InterQual or Milliman to identify and support the appropriate level of care.</li> <li>Abstract data from a variety of medical records to ensure accurate clinical data.</li> <li>Adhere to established quality, timeliness, and productivity outputs required in the completion of first-level nursing utilization review.</li> <li>Perform other duties as assigned by departmental leadership in support of departmental and organizational strategies and goals which may include system testing, training, and other opportunities that promote growth.</li> </ul>Required Skills:<ul><li>Active Registered Nurse (RN) license in your state of residence, with eligibility to obtain a California RN license</li></ul>For this US-based position, the base pay range is $18.69 - $39.35 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a <a href="http://go.r1rcm.com/benefits" target="_blank">competitive benefits package.</a>R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights <a href="https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf" target="_blank">California Consent </a>To learn more, visit: <a href="https://R1RCM.com" target="_blank">R1RCM.com</a>Visit us on <a href="https://www.facebook.com/R1RCM" target="_blank">Facebook</a>

Utilization Review Author

Job Description R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. The Multi Specialty Denial Coding Associate II will be responsible for reviewing clinical documentation and diagnostic results as appropriate (i.e., to extract data and apply appropriate ICD-10-CM, HCPCS and CPT-4 codes for billing, review and correct billing edits, internal and external reporting, research, and regulatory compliance). Under the direction of the Coding Leadership Team, the successful candidate must be able to accurately code conditions and procedures as documented in the ICD-10-CM Official Guidelines for Coding and Reporting. Here’s what you will experience working as our Coding Associate II: <ul> <li>Assigns codes for diagnoses, treatments and procedures according to the appropriate classification system for professional service encounters to determine the highest level of specificity ICD-10 codes, CPT codes, HCPCS codes, and modifiers.</li> <li>Reviews physician assigned diagnosis code after thorough review of the medical record and, if necessary, queries physician for additional clarity in a professional manner.</li> <li>Able to accurately abstract information from the medial records into the abstract system, according to established guidelines.</li> <li>Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC) adheres to official coding guidelines</li> <li>Enters and validates codes, charges and other edits flagged in Athena or EPIC for review.</li> <li>Review documentation (and returned accounts) to verify and correct place of service, billing and service providers, or other missing data elements (ie: NDC #, or number of units)</li> <li>Uses CCI edit software to check bundling issues, modifier appropriateness, and LCD’s/NCD’s for medical necessity.</li> <li>Communication with other departments to recommend coding guidance for charge corrections, appeals processes, and patient billing concerns.</li> <li>Meet and/or exceeds the established coding productivity standards</li> <li>Meet and/or exceeds the established quality standard of 95% accuracy while meeting and/or exceeding productivity standards</li> </ul> Required Qualifications: <ul> <li>High School Diploma or GED required</li> <li>CCS-P, CPC Certification</li> <li>Three (3) years coding experience</li> <li>Must be able to demonstrate proficiency in professional services (95% accuracy).</li> <li>Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA) (ie: Documentation Guidelines ’95 &amp; ’97)</li> <li>Extensive knowledge of government, and commercial payer guidelines.</li> <li>Must be able to use standard office equipment and information systems.</li> <li>Ability to interact with other employees through effective communication.</li> <li>Ability to prioritize and shift workloads to ensure departmental goals align with revenue cycle goals </li> </ul> For this US-based position, the base pay range is $17.58 - $27.14 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a <a href="http://go.r1rcm.com/benefits" target="_blank">competitive benefits package.</a>R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights <a href="https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf" target="_blank">California Consent </a>To learn more, visit: <a href="https://R1RCM.com" target="_blank">R1RCM.com</a>Visit us on <a href="https://www.facebook.com/R1RCM" target="_blank">Facebook</a>

Multi Specialty Denial Coder II

Job Description R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. <h2>Here's what you'll experience as our Coding Educator:</h2> <ul> <li>Create, administer, implement, and update the overall professional services coding education program for coding staff, clinicians, and other stakeholders.</li> <li>Actively works with the Sr Manager of Coding Education, Directors and Managers of Coding Quality Management, Operational Coding Leaders (and/or other members of those teams) to identify areas where focused education may be needed for all coders, coding quality reviewers and subsequently develops the curriculum and plan for educating all onshore and offshore coders via identifying the root cause, developing a plan of action and reporting outcomes.</li> <li>Monitor coding quality and accuracy, identify areas of improvement, and provide feedback and coaching.</li> <li>Ability to create and present material to all coding staff.</li> <li>Administers curricula and “real world examples” for all coders, coding quality reviewers, clinicians, and other stakeholders to acquire the knowledge and skills necessary for competency and meet quality standards.</li> <li>Tracks, manages, and reports all education activities for all assignments.</li> <li>Maintains knowledge of all current coding regulatory guidelines and governmental updates and communicates those changes to current staff and leadership to support appropriate, compliant coding.</li> <li>Maintains training collateral across multiple multimedia forums so that information is organized, highly presentable and updated.</li> <li>Provides constructive review and feedback to assist in the development of instructional materials to include course plans, objectives, and evaluation tools.</li> <li>Shift variation, as needed, for offshore collaboration and education sessions.</li> </ul> <h2>The successful candidate must have demonstrated skills to include:</h2> <ul> <li>Adapts to match the shifting demands of the organization when confronted by different situations.</li> <li>Responds positively to change and embraces new practices or methods when trying to accomplish goals and solve problems.</li> <li>Continues to make progress when things are unclear or not yet finalized.</li> <li>Recovers quickly from setbacks and finds alternative ways to reach goals or targets.</li> </ul> Required Qualifications: <ul> <li>This role typically requires an associate’s degree. In lieu of a degree, a comparable combination of education and experience (including military service) may be considered.</li> <li>AAPC credentialing as a Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist-Physician (CCS-P)</li> <li>Minimum of five years of experience in coding multi-specialties.</li> <li>Ability to interact with other employees through effective communication.</li> <li>Excellent communication skills and ability to deliver and teach complex coding concepts to large groups of coders.</li> <li>Soft skills.</li> <li>Strong problem-solving skills.</li> <li>Preferred specialty knowledge in OBGYN, Ophthalmology, and Surgery</li> </ul> Desired Qualifications: <ul><li>Previous teaching and/or training experience.</li></ul> For this US-based position, the base pay range is $18.69 - $39.35 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a <a href="http://go.r1rcm.com/benefits" target="_blank">competitive benefits package.</a>R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights <a href="https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf" target="_blank">California Consent </a>To learn more, visit: <a href="https://R1RCM.com" target="_blank">R1RCM.com</a>Visit us on <a href="https://www.facebook.com/R1RCM" target="_blank">Facebook</a>

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