Outpatient Coder, Rules & Optimization

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. 

As our Outpatient Coder, you will play a crucial role in reviewing outpatient facility documentation and developing strategies for appeals. Every day you will utilize coding resources and applicable reference materials to ensure accuracy in coding. Additionally, you will be responsible for creating and optimizing rules and enhancements to identify and address future issues. To thrive in this role, you must possess strong analytical skills to interpret data and develop effective solutions.

 

Key Responsibilities:

• Review outpatient hospital facility, clinic, and physician documentation, including medical records, UB-04s, EOBs, itemized bills, and remittance advices to determine appropriate code assignments for services provided (CPT/HCPCS codes).
• Maintain proficiency in ICD-10-CM, CPT, and HCPCS coding, including the use of appropriate modifiers and revenue codes, and knowledge/application of NCCI edits for CPT/HCPCS.
• Review payer policies, including CMS LCDs, NCDs, and Articles, to assist in developing a strategy for appeals.
• Create arguments and draft appeal letters that are well-written and logically structured.
• Assist other departments with coding and reimbursement issues.
• Utilize proprietary software systems to obtain work assignments and assist in creating workflow efficiencies.
• Develop and optimize coding rules and enhancements to preemptively address potential coding issues.
• Analyze coding data to identify trends and areas for improvement, implementing strategies to enhance coding accuracy and efficiency.

 

Required Skills:

• CPC, CPC-H (COC), CIC, RHIA, RHIT, or CCS certification.
• 5+ years of experience in billing, charge documentation, charge audit, charge capture, or other functions related to revenue cycle activities.
• Strong analytical skills with the ability to interpret complex data and develop actionable insights.
• Comprehensive understanding of medical terminology, coding, payer policies, and various payment methodologies.

For this US-based position, the base pay range is $47,237.00 - $78,919.86 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

This job is eligible to participate in our annual bonus plan at a target of 5.00%

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

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To learn more, visit: R1RCM.com

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