Coding Integrity Specialist

R1 RCM, Inc.; Detroit (MI); Remote; USD 39,000 - 55,000; Full time

Job summary

R1 RCM, a leader in healthcare revenue management, seeks a Coding Integrity Specialist to join its remote US team. You will collaborate with Coding Operations leadership to conduct complex coding quality reviews and ensure compliant, accurate DRG coding for hospital clients.

The role requires a bachelor's or associate degree in HIM or CCS, plus at least 5 years of inpatient coding. Compensation ranges from $28.24 to $40.21 per hour, with benefits and growth opportunities across a national

Qualifications

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

Responsibilities

• 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.

Skills

Inpatient coding

Analytical skills

Education

Bachelor's or associate’s degree in HIM related fields or CCS credential

Job description

Remote, USA

Full time

R260000003119

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 Coding Integrity Specialist , you will works with the Coding Integrity Manager and Director of Coding Operations to establish open lines of communication regarding potential coding quality concerns. Every day you will, leads, coordinates, and performs coding quality reviews. To thrive in this role you must, strong analytical skills and ability to comprehend and analyze large quantities of operational data, ability to review complex medical records and strong ability to multi-task and prioritize work assignments

Here’s what you will experience working as a Coding Integrity Specialist:

• 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.

Required Skills:

• Bachelor's or associate’s degree in HIM related fieldsor CCS credential is required.

• Minimum 5 years of inpatient coding.

For this US-based position, the base pay range is $28.24 - $40.21 per hour . Individual pay is determined by role, level, job-related skills, experience, and relevant education or training.

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. (http://go.r1rcm.com/benefits)

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.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent (https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf)

To learn more, visit: R1RCM.com

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R1 is the leader in healthcare revenue management, helping providers achieve new levels of performance through smart orchestration. A pioneer in the industry, R1 created the first Healthcare Revenue Operating System: a modular, intelligent platform that integrates automation, AI, and human expertise to strengthen the entire revenue cycle. With more than 20 years of experience, R1 partners with 1,000 providers, including 95 of the top 100 U.S. health systems, and handles over 270 million payer transactions annually. This scale provides unmatched operational insight to help healthcare organizations unlock greater long-term value. To learn more, visit: https://www.r1rcm.com .