Team Lead, CAU Appeals Triage Follow-Up

R1 RCM; United States; Remote; USD 10,000 - 60,000; Full time

Job summary

A leading provider in revenue cycle management is seeking a Team Lead for CAU Appeals Triage Follow-Up to optimize claims processing and enhance department productivity. This role requires experience in revenue cycle processes and offers growth opportunities within a supportive environment committed to quality and collaboration.

Benefits

Competitive benefits package

Opportunities for continuous learning

Collaborative work environment

Qualifications

• 3 – 5 years of revenue cycle experience required.
• Positive attitude and good decision-making abilities are essential.
• Intermediate skill level in Microsoft applications understandable.

Responsibilities

• Perform and validate claim level denials and manage denial inventory.
• Review account information and document pertinent details thoroughly.
• Identify and resolve problems while developing process improvements.

Skills

Excellent written and verbal communication skills

Ability to work well independently and in teams

Ability to prioritize and multi-task

Medical terminology

Education

High School Diploma or GED

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Microsoft Outlook

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.

Job Responsibilities:

Perform and validate claim level denials and denials inventory.

Successfully review account information, interpret Explanation of Benefits/UB04 forms, and all necessary system applications to determine the next most value[1]added work activity and thoroughly document all pertinent information.

Identify and resolve problems in a timely manner; gather and analyze information skillfully; develop alternative solutions; consider and identify automation and process improvement opportunities; work well in a group problem-solving environment.

Meet and maintain established department productivity and quality metrics

Review and validate necessary documentation required by the appeals team.

Effectively collaborate with other departments via system applications and communication programs.

Regularly provide feedback and recommendations for cross-functional process improvements.

Document findings from account-level reviews to identify denial root causes.

Communicate trends and escalation issues to management as identified.

Maintain a knowledge of payer guidelines as they relate to denials, claims processing, and appeals processing.

Maintain an effective documentation standard that supports a strong historical record of actions taken on the account.

Required Qualifications:

High School Diploma or GED.

Intermediate skill level of Microsoft Word, Excel, PowerPoint and Outlook.

Excellent written and verbal communication skills.

Ability to work well independently and in teams.

Ability to prioritize, multi-task and work in a fast-paced, high-volume environment. Demonstrates good decision-making abilities.

Positive Attitude. 3 – 5 years of revenue cycle experience.

Medical terminology.

For this US-based position, the base pay range is $17.18 - $28.52 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

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.

Team Lead, CAU Appeals Triage Follow-Up

Job Responsibilities:

• Perform and validate claim level denials and denials inventory.

• Successfully review account information, interpret Explanation of Benefits/UB04 forms, and all necessary system applications to determine the next most value[1]added work activity and thoroughly document all pertinent information.

• Identify and resolve problems in a timely manner; gather and analyze information skillfully; develop alternative solutions; consider and identify automation and process improvement opportunities; work well in a group problem-solving environment.

• Meet and maintain established department productivity and quality metrics

• Review and validate necessary documentation required by the appeals team.

• Effectively collaborate with other departments via system applications and communication programs.

• Regularly provide feedback and recommendations for cross-functional process improvements.

• Document findings from account-level reviews to identify denial root causes.

• Communicate trends and escalation issues to management as identified.

• Maintain a knowledge of payer guidelines as they relate to denials, claims processing, and appeals processing.

• Maintain an effective documentation standard that supports a strong historical record of actions taken on the account.

Required Qualifications:

High School Diploma or GED.

Intermediate skill level of Microsoft Word, Excel, PowerPoint and Outlook.

Excellent written and verbal communication skills.

Ability to work well independently and in teams.

Ability to prioritize, multi-task and work in a fast-paced, high-volume environment. Demonstrates good decision-making abilities.

Positive Attitude. 3 – 5 years of revenue cycle experience.

Medical terminology.

For this US-based position, the base pay range is $17.18 - $28.52 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 RCM Inc. is an American revenue cycle management company servicing hospitals, health systems and physician groups across the United States.

Notice

Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at [e-mail] or 407-000-0000.

Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.

An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report . NYC applicants may request an alternative process or accommodation at [e-mail] or 407-000-0000.