Coding Integrity Specialist

🔥 1 hour ago

🇺🇸 United States – Remote

💵 $42 - $45 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

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R1 RCM

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2017

⚕️ Healthcare Insurance

☁️ SaaS

💸 Finance

💰 Private Equity Round on 2024-07

Healthcare Insurance • SaaS • Finance

R1 RCM is a leading provider of revenue cycle management solutions for the healthcare industry. With an emphasis on maximizing financial performance and optimizing patient care, R1 offers a comprehensive platform that integrates data analytics, intelligent technologies, and deep expertise in revenue cycle management. The company assists healthcare providers—ranging from hospitals and health systems to physician and specialty care practices—in capturing revenue opportunities, improving payer and patient cash flows, and ensuring compliance with government regulations. R1 is committed to driving cost reductions and revenue improvements while enhancing the patient experience. Their suite of services includes revenue recovery, clinical integrity, and regulatory navigation, making them a trusted partner for many top healthcare providers.

📋 Description

• Conduct complex coding reviews related to reimbursement, public reporting, and pay for performance. • Collaborates with the CDI team, assisting with the resolution of documentation inconsistencies, DRG variances, and CDI and internal operations. • Ensures that the DRG or reimbursement accurately reflects the services/utilization of resources provided by the hospital. • Performs second level focused pre-bill and post-bill account reviews to ensure accurate coding. • Conduct complex 360 coding reviews which include identification and correction of coding, and trending for documentation, coding denials, billing, and charging. • Evaluate for coding accuracy/specificity to assist with preventing possible loss of revenue for the hospital related to value-based payment programs.

🎯 Requirements

• Bachelor's or associate’s degree in HIM related fields or CCS credential is required. • Minimum 5 years of inpatient coding.

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Flexible working arrangements • Professional development opportunities • Competitive benefits package