Outpatient Quality Reviewer

R1 RCM Holdco Inc.; Illinois; Hybrid; USD 39,000 - 55,000; Full time

Job summary

R1 RCM Inc. is seeking an Outpatient Quality Reviewer to audit outpatient coding for accuracy across CPT®, HCPCS, ICD-10-CM, modifiers and APCs. You will advise coding staff and educate teams while collaborating with Quality, Education, Denials, and Coding Operations.

You will stay current with CMS, AMA, and industry guidelines, supporting continuous improvement, remote work, and performance standards in a healthcare revenue cycle environment.

Qualifications

• Must have High School diploma or GED.
• Minimum seven (7) years of hospital outpatient coding experience including Ancillary, Emergency Department, Same Day Surgery, Observation, Wound Care, E/M Professional services, Interventional Cardiology, and Interventional Radiology.

Responsibilities

• Review outpatient records to ensure CPT, HCPCS, ICD-10-CM, modifier, and APC code assignments are complete and accurate.
• Provide audit feedback and coaching to promote coding excellence and consistency across teams.
• Analyze audit results and identify trends for education, process improvement, and quality enhancement.
• Collaborate with Quality, Education, Denials, and Coding Operations to resolve coding issues and support revenue integrity.
• Stay current on CMS, AHA, AMA guidelines to ensure regulatory compliance.
• Support a remote environment with a focus on accuracy, productivity, and performance.

Education

High School diploma or GED

RHIT

RHIA

COC

CCS-P

CCS

Bachelor's or Associate Degree

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.

The Outpatient 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.

Here is what you will experience working as an Outpatient Quality Reviewer:

• 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.

Required Skills

• 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.

Preferred Skills

• Bachelor's or Associate Degree

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.

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.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent To learn more, visit: R1RCM.com Visit us on Facebook 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.