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, patient’s 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. 

The Coding Denial Auditor will be responsible for reviewing denial coded cases for coding completeness and accuracy.  This person will identify potential coding and DRG errors, researches appropriate guidelines to support recommended changes, and communicates the changes to the coder involved on a timely basis. The Reviewer provides expert coding advice to coding staff and relays needed coding educational topics to the Regional Manager, IP Coding Quality.  

 

Responsibilities:   

Audits records as defined in the coding quality review plan. Review cases flagged by the coding quality software on a daily basis for multiple hospitals, including validating the completeness of documentation, identifying diagnoses and procedures that have been missed, proposing physician queries, and ensuring the accuracy of diagnoses, procedures, POA, discharge disposition and DRG assignment 

Perform retrospective coding quality reviews as requested 

Follows, and maintains up-to-date knowledge of, industry coding and documentation guidelines (e.g., Official ICD-10 Coding and Billing Guidelines, Coding Clinic advice, R1 and Ascension coding policies and procedures, and AHIMA/ACDIS Query Guidelines) so as to maintain system-wide coding consistency and remain in compliance with governmental and other regulatory guidelines 

Communicates audit findings with coders in a timely manner and supports the teams in effectively and efficiently addressing and resolving local coding issues 

Maintains both a high productivity rate and a high accuracy rate in accordance with established auditing standards 

Serves as an inpatient coding expert & resource for the coding teams and other departments 

Works with the Regional Manager to identify areas of educational need based on audit results 

Reports to, and works with, the Regional Manager to identify improvements in the audit software tool, workflow processes and flag management; and assist with evaluation and testing of audit applications and updates as needed 

Work with the hospital’s CDI team to address and resolve documentation issues 

Assists with compilation, generation and analysis of data for results reporting and performance Improvement initiatives 

Contributes to the reduction of the hospital's and Company’s coding compliance risks and contributes to the Company’s revenue enhancement goals 

Maintains an open dialogue and a good working relationship with team members in order to advance the mission and objectives of the hospitals and R1 

Assists with training of new auditors. Assists with other audits and duties as requested 

 

Pacific Time Zone working hours

Required Qualifications:   

Bachelor's or Associates Degree with CCS credential is required 

A minimum of seven (7) years of hospital inpatient coding experience is required 

Extensive knowledge of ICD-10-CM/PCS classification system and MS-DRG and APR-DRG methodologies is required 

In-depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required 

Expert and up-to-date knowledge of industry Official Coding and Reporting Guidelines along with CMS and other agency directives for ICD-10 coding 

Must have proficient MS Office computer skills, specifically in Excel and knowledge of various coding software/platforms and EMRs 

Must be detail-oriented and have the ability to work independently and maintain a high productivity rate and coding accuracy rate 

Ability to interact with other employees through effective communication Must be a self-starter 

 

Desired Qualifications:   

Two (2) years of inpatient coding audit experience is preferred 

Experience in a large (> 500 beds) hospital or multi-hospital health system is preferred 

Training in hospital Clinical Documentation Improvement is preferred 

Experience as a Coding Consultant with a consulting firm is preferred 

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. To learn more, visit: r1rcm.com. 

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 competitive benefits package.

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

To learn more, visit: R1RCM.com

Visit us on Facebook

#li-remote #coding #healthcare #insurance #ccs