R1 is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals, and physician practices. Headquartered in Chicago, R1 is publicly traded organization with employees throughout the US and international locations.
Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients, and each other. With our proven and scalable operating model, we complement a healthcare organization's infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.
The Appeals and Denials Author will serve as an expert on appeals and denials management and will represent client hospitals where claims were denied by governmental contractors or commercial payers. The position will involve a thorough review of patient clinical and hospital course documentation as well as payer policy and denial information. Once reviewed, the Appeals and Denials Author will prepare an appropriate written document and represent client hospitals during hearings, if needed.
In this role, the successful candidate must have experience in a clinical environment and the ability to use sound judgment in reviewing clinical documentation supporting patient care as well as conceptual knowledge of the denials landscape within the healthcare industry.
Responsibilities:
Navigates through web-based portals and independently utilizes other online tools and resources including but not limited to Microsoft Word, Adobe, Excel
Conducts detailed review of patient medical records and payer denial information submitted by clients.
Assesses the entire hospital stay and clinical course of patient.
Identifies risk factors, comorbidities and adverse events to determine if payer denial was justified for that particular hospital stay or service.
Reviews governmental regulations and payer protocols and / or medical policy to recommend appropriate actions.
Prepares written appeals or represents client at telephonic hearings (as needed)
Research medical literature and evidence based medical publications to support patient care.
Exercises clinical judgment and experience.
Required Qualifications :
RN with current license and strong appeals experience
2+ years of clinical experience with inpatient care
Knowledge of, or experience in working with the verbal and written appeals process
Must have experience with electronic medical record systems.
Understanding of DRG/coding principles
Familiar with both inpatient and outpatient care and procedures in multiple specialties
Desired Qualifications:
Excellent verbal and written communication skills
Experience participating in ALJ Hearings preferred.
Experience in Hospital Billing
For this US-based position, the base pay range is $45,409.55 - $87,948.00 per year . 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. (http://go.r1rcm.com/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, 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.
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To learn more, visit: R1RCM.com
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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.
Headquartered near Salt Lake City, Utah, R1 employs over 29,000 people globally and is traded on the Nasdaq stock exchange under the symbol "RCM."