Clinical Appeals Supervisor

R1 RCM; United States; Remote; USD 84,000 - 140,000; Full time

Job summary

A leading company in technology-driven healthcare solutions is seeking a Clinical Appeals Supervisor to oversee clinical operations and ensure quality metrics are met. The role requires a Registered Nurse license and entails regular audits and collaboration with non-clinical staff on appeals processing. Join a dynamic team dedicated to improving patient care and financial performance.

Benefits

Competitive benefits package

Qualifications

• Supervised clinical inpatient environment required.
• Proficiency in basic computer skills essential.

Responsibilities

• Supervise day-to-day clinical operations and functions.
• Track workflow of clinical team for compliance.
• Assess cases for external review or escalation.

Skills

Supervision

Clinical Documentation Review

Judgment

Computer Skills

Education

Active Registered Nurse license

Job description

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 Clinical Appeals Supervisor, you will help support clinicians who conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical necessity criteria, physician documentation, and medical policies of the payor. Every day you will supervise the day-to-day clinical operations and functions within the department, ensuring productivity and quality metrics are met and regularly identify and communicate denial trends and patterns to leadership. To thrive in this role, you must have experience supervising in a clinical inpatient environment and the ability to use sound judgment in reviewing clinical documentation supporting patient care as well as conceptual knowledge of the denials landscape. Proficiency in basic computer skills is essential for excelling in this remote position.

Here’s what you will experience working as a Clinical Appeals Supervisor:

• Track and monitor the workflow of the clinical team daily to ensure internal and external compliance deadlines are met.
• Track clinicians’ productivity and quality by performing regular audits of appeals. Evaluate and report on overturned appeals to continuously refine clinical practices and ensure optimal outcomes.
• Assess the viability of cases for external review or escalation, as well as make final determinations on clinical appeals that require no further action.
• Act as a liaison for non-clinical staff and attorneys to collaborate on appeals processing.
• Leverage employee engagement data to identify targeted areas for additional support and engagement.

Required Skills:

• Active Registered Nurse license

For this US-based position, the base pay range is $84,456.00 - $139,823.91 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 10.00%

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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