Clinical Coding Reviewer

at R1 RCM in Boise, Idaho, United States

R1 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 publicly traded 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.

As our Clinical (Coding) Reviewer, you will review and interpretation of medical records to draft appeals of denied and underpaid claims. Every day you will, review medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes. To thrive in this role you must draft appeal letters based on clinical judgment and knowledge and making coding change suggestions to our clients based on ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance, and Coding Clinic.

Responsibilities:

+ Familiarity with and ability to identify different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters.

+ Review and interpret medical records to appeal denied and underpaid claims.

+ Apply clinical judgment and knowledge for DRG downgrades performed as a result of a Clinical Validation Review by an insurer or third-party auditor.

+ Draft appeal letters that are well written, logically structured, and persuasive, utilizing ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance, and Coding Clinic.

+ Handle rush and high balance cases in accordance with office policy for prioritization.

+ Ensure that all appeals are completed timely and sent by the specified deadline.

Required Qualifications:

+ Licensure as a Registered Nurse (RN) or Licensed Practical Nurse (LPN/LVN)

+ Active CPC or CCS certification; or, in lieu of active coding certification, a minimum of 2 years of experience in a Clinical Documentation Improvement (CDI) position

+ Direct experience in medical record reviews/audits

For this US-based position, the base pay range is $60,000.00 - $86,842.00 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

Learn more about Benefits (http://go.r1rcm.com/benefits) at R1

Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.

Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package including:

+ Comprehensive Medical, Dental, Vision & RX Coverage

+ Paid Time Off, Volunteer Time & Holidays

+ 401K with Company Match

+ Company-Paid Life Insurance, Short-Term Disability & Long-Term Disability

+ Tuition Reimbursement

+ Parental Leave

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 California Consent (https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf)

To learn more, visit: R1RCM.com

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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.

Headquartered near Salt Lake City, Utah, R1 employs over 29,000 people globally and is traded on the Nasdaq stock exchange under the symbol "RCM."