Complex Denials Consultant

R1 RCM; United States; On-site; USD 90,000 - 112,762; Full time

Job summary

R1 RCM is seeking a Complex Denials Consultant to represent and counsel healthcare providers in disputes with insurance carriers. This role involves contract review, appeal writing, and understanding regulations related to payment and coverage. The successful candidate will have a law degree and must be barred in one state or eligible within six months. The position offers a competitive salary range of $90,000 to $112,762 annually plus a 10% annual bonus target.

Qualifications

• Must be barred in one state or bar-eligible within 6 months of graduation.

Responsibilities

• Assist recovery staff in pursuing appeals.
• Draft complex and contractual appeals and letters to insurance companies.
• Review and apply client contract language and rates to resolve denied claims.
• Utilize payer-provider and administrative manuals to dispute denied claims.
• Contact provider representatives to resolve complex claim and appeal issues.
• Represent clients during Administrative Law Judge hearings as needed.
• Assist with training recovery staff team members.
• Apply provider-specific reimbursement methodologies to confirm payment.

Education

Law degree from an accredited college or university

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.

Role Overview

As our Complex Denials Consultant, you will represent and counsel healthcare providers in their disputes with medical insurance carriers and managed care organizations at all stages of the administrative appeals process. You will handle contract review and appeal template development based on contractual provisions and applicable state and federal laws, writing appeals and letters to insurance companies to resolve denials, and reviewing high-balance or complex accounts. To thrive in this role, you must maintain a foundational understanding of Commercial, Governmental, Managed Care, and ERISA regulations regarding payment, coverage, conditions of participation, and other relevant topics.

Responsibilities

• Assist recovery staff in pursuing appeals, developing new and innovative legal and procedural arguments and tools.
• Draft complex and contractual appeals and letters to insurance companies.
• Review and apply client contract language and rates to resolve denied claims.
• Utilize payer-provider and administrative manuals to dispute denied claims.
• Contact provider representatives or higher-level resolution units to resolve complex claim and appeal issues.
• Represent clients during Administrative Law Judge hearings as needed.
• Assist with training recovery staff team members and provide necessary feedback as requested by management.
• Apply provider-specific reimbursement methodologies, payment policies, and provider contracts to fully confirm payment.

Qualifications

• Law degree from an accredited college or university.
• Barred in one state or must be bar-eligible within 6 months of graduation.

Compensation & Benefits

For this US-based position, the base pay range is $90,000.00 - $112,762.49 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%.

R1 RCM Inc. (“the Company”) is dedicated to 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. The Company is also 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.