Outpatient Coding Quality Reviewer at R1 RCM


Outpatient Coding Quality Reviewer – Pro-Fee, Remote USA (Full Time)

Location: United States
Employment Type: Full-Time; Remote USA
Shift: Monday- Friday, Hours will vary.

R1 RCM Inc. is a leading provider of technology-enabled revenue cycle management services that transform and solve challenges across health systems, hospitals and physician practices. Headquartered in Chicago, R1® is a 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.

Set your sights on a role making a real difference in the healthcare system. We’re looking for a self-motivated Pro-Fee Coding Quality Reviewer to join our team. We have a relentless focus on driving results for our customers and enabling them to invest more into patient care; in turn, this allows us to continue to grow our company and your career.

The Outpatient Coding Quality Reviewer – Pro-Fee is responsible for performing professional services reviews for coding completeness and accuracy.

Your day to day role will include:

  • Audits specified number of records per coder as defined in the system coding audit plan.
  • Performs the professional services audits to include the E/M level, CPT/HCPCS procedures, modifiers, and ICD-10 diagnosis codes.
  • Evaluates the clinical documentation to identify any trends, specifically for incomplete documentation or lacking details that could impact the accuracy of the professional E/M code assignment.
  • Prepares and distributes audit results/reports for the system coding compliance program.
  • Identifies patterns and/or trends for educational opportunities.
  • Prepares and presents educational programs related to coding.
  • Assists with other audits as requested. * Maintains up to date knowledge of ICD-10 and CPT coding guidelines.
  • Acknowledges that in working together, the team is able to accomplish more than you can individually by collaborating to achieve a shared purpose.
  • Maintains an open dialogue and a good working relationship with all members of the team in order to advance the mission and objectives of their ministry.
  • Positively influences the behavior of others in the accomplishment of organizational, division and departmental strategies.
  • Develops relationships with specific individuals that promote positive growth.
  • Continually evaluates and advances his/her skills and expertise associated with his/her position.
  • Supports customer service by treating others with courtesy, compassion, and kindness while maintaining their dignity and respecting their individual opinions and beliefs.
  • Projects a positive image through actions, words, and appearance.

You Have:

  • Bachelor’s Degree or Associate’s Degree in HIM preferred. CCS-P, CPC and/or COC required.
  • Minimum of 3 years of professional coding experience, HCC/RAF experience, and previous audit experience preferred. * Must be able to concentrate on very detailed work.
  • Minimum of 3 years of professional coding experience in Cardiovascular Surgery required (vascular/non-vascular)
  • Experience working Athena edits and billing denials preferred.
  • Extensive knowledge of federal, state, and payer-specific regulations, policies and CMS guidelines as it pertains to documentation, coding and billing of professional services.
  • Must maintain the highest confidentiality of medical record information.
  • Ability to interrelate to physicians concerning documentation clarification and coding concerns.
  • Possesses and applies knowledge, skills, and abilities necessary to identify and meet patient/family age-specific needs.
  • Microsoft Excel knowledge

It would be great if you also have:

  • Experience working in a healthcare environment
  • Epic/Athena experience.

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.

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