Outpatient Coding Quality Reviewer

R1 RCM, Inc.; Alton (IL); On-site; USD 39,000 - 55,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

R1 RCM, Inc. is seeking an Outpatient Coding Quality Reviewer to review outpatient coded cases across Ancillary, Emergency Department, Same Day Surgery, Observation, Wound Care, Professional Services, Interventional Cardiology and Interventional Radiology.

You will provide expert coding guidance and identify opportunities for education and process improvement, partnering with Quality, Education, Denials and Coding Operations to support revenue integrity while ensuring compliance.

Qualifications

• High School diploma or equivalent is required.
• Active certification(s): RHIT, RHIA, COC, CCS-P or CCS are required.
• A minimum of seven (7) years of hospital outpatient coding experience is required.
• Bachelor's or Associate Degree is required.

Responsibilities

• Ensure coding accuracy and compliance by conducting quality reviews of outpatient records and validating CPT®, HCPCS, ICD-10-CM, modifier, and APC code assignments.
• Serve as a trusted coding subject matter expert, providing audit feedback, coaching, and guidance that promotes coding excellence and consistency across teams.
• Analyze audit results and identify trends to uncover opportunities for education, process improvement, and quality enhancement.
• Partner with cross-functional teams, including Quality, Education, Denials, and Coding Operations, to resolve coding issues and support revenue integrity initiatives.
• Stay current on industry regulations and coding guidelines, ensuring compliance with CMS, AHA, AMA, and other regulatory requirements.
• Drive continuous improvement through collaboration, training, and process optimization while maintaining exceptional accuracy, productivity, and performance in a remote environment.

Education

High School diploma, GED or equivalent

Bachelor's or Associate Degree

Job description

About R1

At R1, we’re transforming how healthcare works by combining nearly two decades of revenue cycle expertise with advanced technology, including analytics, AI, intelligent automation and workflow orchestration. We pair that technology with the irreplaceable expertise of our people to help hospitals, health systems and medical groups improve financial performance, simplify administrative complexity and create better experiences for patients and providers. We’re a diverse, global team united by a shared mission to make healthcare work better for all. Across technology, operations and support functions, our people bring deep expertise, empathy and ingenuity to the work we do. Here, collaboration fuels progress, adaptability sparks innovation and every voice can help shape what’s next for R1 and the future of healthcare.

Role

The Outpatient Coding Quality Reviewer is responsible for reviewing outpatient coded cases including but not limited to Ancillary, Emergency Department, Same Day Surgery, Observation, Wound Care, Professional Services, Interventional Cardiology and Interventional Radiology for coding completeness and accuracy. This position identifies potential coding and APC/payment opportunities, research appropriate guidelines to support recommended changes, and communicates the changes to the coder or quality reviewer involved on a timely basis. The Outpatient Quality Reviewer provides expert coding advice to coding staff, global quality reviewers and relays needed coding educational topics to the Manager of Outpatient Coding Quality.

Key Responsibilities

• Ensure coding accuracy and compliance by conducting quality reviews of outpatient records and validating CPT®, HCPCS, ICD-10-CM, modifier, and APC code assignments.
• Serve as a trusted coding subject matter expert , providing audit feedback, coaching, and guidance that promotes coding excellence and consistency across teams.
• ~ Analyze audit results and identify trends to uncover opportunities for education, process improvement, and quality enhancement.
• ~ Partner with cross-functional teams , including Quality, Education, Denials, and Coding Operations, to resolve coding issues and support revenue integrity initiatives.
• ~ Stay current on industry regulations and coding guidelines , ensuring compliance with CMS, AHA, AMA, and other regulatory requirements.
• ~ Drive continuous improvement through collaboration, training, and process optimization while maintaining exceptional accuracy, productivity, and performance in a remote environment.

Qualifications

• High School diploma, GED or equivalent
• ~ Required one or more active certification(s): RHIT, RHIA, COC, CCS-P or CCS
• ~ A 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) is required.
• ~ Bachelor's or Associate Degree

Compensation

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

Benefits

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. 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.

EEO Statement

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