Coding Integrity Specialist

🕒 July 29

🇺🇸 United States – Remote

💵 $28 - $40 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 30%

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R1 RCM

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2017

💼 Consulting

📦 Logistics

🏥 Healthcare

💰 Private Equity Round on 2024-07

Consulting • Logistics • Healthcare

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

• Establish open communication with the Coding Integrity Manager and Director of Coding Operations regarding potential coding quality concerns • Lead, coordinate, and perform coding quality reviews • Conduct complex coding reviews related to reimbursement, public reporting, and pay for performance • Collaborate with CDI teams to resolve documentation inconsistencies, DRG variances, and operational requirements • Ensure DRG or reimbursement accurately reflects hospital services and resource utilization • Collaborate with hospital/client leadership to validate proper coding and reimbursement for service lines and technology • Perform second-level focused pre-bill and post-bill account reviews for coding accuracy, quality, and risk; escalate for final review or write-off approval • Conduct complex 360 coding reviews and identify, correct, and trend documentation, coding denials, billing, and charging issues • Evaluate coding accuracy and specificity to prevent revenue loss related to value-based payment programs and public reporting • Provide coding corrections education and feedback to coders and coding managers • Identify coding trends requiring formal education and collaborate with education, integration, and project management teams on system and mapping updates • Perform ad hoc Cloudmed DRG Validation Reviews based on client needs

🎯 Requirements

• Bachelor's or associate’s degree in HIM related fields or CCS credential is required • Minimum 5 years of inpatient coding • Strong analytical skills • Ability to comprehend and analyze large quantities of operational data • Ability to review complex medical records • Strong ability to multitask and prioritize work assignments

🏖️ Benefits

• Competitive benefits package • Opportunities to constantly learn, collaborate across groups, and explore new career paths • Meaningful work contributing to communities served around the world • Reasonable accommodation available for applicants with disabilities