Remote Inpatient 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

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