Outpatient Quality Reviewer

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $28 - $40 / hour

⏰ Full Time

🟠 Senior

🔴 Lead

🦅 H1B Visa Sponsor

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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

• Review outpatient coded cases for coding completeness and accuracy • Identify potential coding and APC/payment opportunities • Research appropriate guidelines to support recommended changes • Communicate coding changes to coders or quality reviewers in a timely manner • Provide expert coding advice to coding staff and global quality reviewers • Relay needed coding education topics to the Manager of Outpatient Coding Quality • Conduct quality reviews of outpatient records and validate CPT®, HCPCS, ICD-10-CM, modifier, and APC code assignments • Provide audit feedback, coaching, and guidance • Analyze audit results and identify trends for education, process improvement, and quality enhancement • Partner with Quality, Education, Denials, and Coding Operations teams to resolve coding issues and support revenue integrity initiatives • Stay current on industry regulations and coding guidelines • Drive continuous improvement through collaboration, training, and process optimization while maintaining accuracy, productivity, and performance in a remote environment

🎯 Requirements

• High School diploma, GED or equivalent • Required one or more active certification(s): RHIT, RHIA, COC, CCS-P or CCS • Minimum of seven (7) years of hospital outpatient coding experience, including Ancillary, Emergency Department, Same Day Surgery, Observation, Wound Care, E/M Professional service, Interventional Cardiology, and Interventional Radiology • Preferred Bachelor's or Associate Degree • Knowledge of CPT®, HCPCS, ICD-10-CM, modifier, and APC code assignments • Knowledge of CMS, AHA, AMA, and other regulatory requirements

🏖️ Benefits

• Competitive benefits package • Opportunities to constantly learn, collaborate across groups, and explore new career paths • Opportunity to contribute, think boldly, and create meaningful work • Reasonable accommodation support for applicants with disabilities