Coding Integrity Specialist

🕒 May 26

🇺🇸 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 to ensure KPIs, SLA, RIS, and DNFB requirements. • Ensures that the DRG or reimbursement accurately reflects the services/utilization of resources provided by the hospital to optimize the impacts of case mix index reporting. • Collaborates with hospital/client leadership to validate proper coding for appropriate reimbursement for specific service lines and technology which assists hospitals in determining if that technology is a positive return on investment. • Performs second level focused pre-bill and post-bill account reviews to ensure accurate coding, review for quality and risk (HAC, PSI, Mortalities, Core Measures and CMS Initiatives) and escalation for final review which may include approval for write-off. • Conduct complex 360 coding reviews which include identification and correction of coding, and trending for the following issues: documentation, coding denials i.e medical necessity, 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 and public reporting. • Provide education/feedback to coders/coding managers regarding coding corrections via automated individual notifications. • Identify coding trends that require formal education by the R1 Education and Training team and work with integration teams and project management teams to test and give feedback on updates to systems and mappings. • Perform ad hoc, Cloudmed DRG Validation Reviews or requests based on client specific wants or needs.

🎯 Requirements

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

🏖️ Benefits

• competitive benefits package