R1 RCM

Eligibility Criteria for Internal Applicants

• Open to all 4I - 5I Clinical employees
• Must be a regular employee or at least 6 months tenure in current role
• No active and ongoing cases or consequence management
• Must have passing scorecard in the past 3 months
• At least 1 year experience in each specialty with a minimum of 2 specialties – Same Day Surgery, Observation, Interventional Radiology, Oncology, Transplant, OB GYNE, Emergency.

Job Description

• As a Multi-Specialty Quality Reviewer, you will be responsible for conducting internal quality reviews across different medical coding specialties to assess coder performance and coding accuracy. This role will focus on identifying areas for improvement, enhancing coding efficiency, and providing educational opportunities to ensure that coding practices meet industry standards and compliance requirements. You will also assist in educating coders, resolving coding issues, and improvement initiatives. Additionally, you are expected to be up to date with the official coding guidelines and payer policies.

Responsibilities

• Conduct audits in various medical coding specialties in outpatient professional settings to assess coding accuracy and ensure adherence to official coding guidelines.
• Provide detailed rationale and supporting references for recommendations and findings.
• Utilize industry-recognized references to support review findings, such as the ICD10-CM Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinic, and AMA CPT Assistant.
• Identify coding error trends across multiple specialties to aid in root cause analysis.
• Stay current with updates in medical coding guidelines, payer-specific requirements, and client-specific requirements.
• Prepare and present reports summarizing audit findings and error trends.
• Identify smart observations for process improvements with quantifiable business impact.
• Calibration sessions between Operations, Quality, and Training to ensure knowledge alignment with client needs and specifications.
• Calibration sessions between processes such as Back-end and Middle Coding.
• Adhere to HIPAA regulations and uphold a high standard of privacy and confidentiality.
• Adhere to all policies and procedures to ensure an efficient workflow process.
• Researching, escalating, and responding to auditor support questions as

triaged by leadership.

• Other duties as assigned by leadership (special projects, assessments, etc.).

Required Qualifications

• Education – Bachelor’s degree in a medical allied course is preferred. For other courses, a high level of knowledge and relevant work experience to illustrate capability
• More than 2 years in the associate position (e.g., Medical Coding / Billing Review).
• At least 5 years of total work experience in medical coding for outpatient professional settings with exposure to multiple specialties.
• At least 1 year experience in each specialty with a minimum of 2 specialties – Same Day Surgery, Observation, Interventional Radiology, Oncology, Transplant, OBGYNE, Emergency.
• License/Certifications: Currently holds and maintains at least 1 role-related certification (CPC, COC, CCS, CCS-P for outpatient roles, CPMA for auditing role).
• Strong knowledge of CMS guidelines, Ambulatory Payment Classification (APC), Outpatient Prospective Payment System (OPPS), and National Correct Coding Initiative (NCCI) edits.
• Experience working with coding software such as Epic, Cerner, Meditech, and 3M 360.

Desired Qualifications

• Additional certifications in specific specialties (CEMC, CASCC, CEDC, CGSC, CHONC, CIRCC, COBGC for specialty roles, CPMA for auditing role) are a plus.
• Experience in professional coding is a plus.
• At least 1 year of experience as a quality auditor is preferred.
• Excellent communication skills, presentation skills, and proficiency in MS Excel & PowerPoint.

. • Proficiency in medical terminologies and disease processes.

Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.

Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits.

What’s in it for you?

• Competitive Total Rewards Package
• Target variable incentives
• Medical Plan (HMO) from Day 1 of employment with free dependents
• Life insurance
• Paid Time-Off Benefits
• Sick Leave Conversion
• Night Differential offered
• Employee Referral Program
• All Mandatory Statutory Benefits

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, or any other characteristic protected by local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

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