Jobs at R1 RCM

Validate and triage clinical data across HL7, FHIR, and Databricks pipelines using SQL. Trace transformations end-to-end, identify and remediate data quality issues, partner with engineering/product/clinical teams, document findings, and support client go-lives to ensure clinically accurate, production-ready data.

Validate and troubleshoot clinical data pipelines for PhareOS across HL7, FHIR, and standardized Databricks/dbt layers. Execute complex SQL validations, trace HL7-to-FHIR transformations end-to-end, investigate and remediate data quality issues, build Databricks queries/notebooks, and collaborate with engineering, product, clinical, and vendor teams to ensure production-ready client data and successful go-lives.

Review payer peer-to-peer authorization denials, evaluate documentation and appropriateness of requested admission status/procedure/care setting, engage with payer medical directors, provide written case analyses across specialties, and serve as a clinical resource to resolve documentation and utilization issues.

Lead setup and QA of client revenue-cycle data feeds, load and validate data, create standardized and ad-hoc reports, analyze results for operations and leadership, maintain health information system data models, implement data validation standards, and drive process improvements to accelerate implementations and improve data quality.

As a Senior Product Manager, you will oversee AI analytics product development, prioritize initiatives, communicate with stakeholders, and manage the product roadmap while ensuring timely delivery of features and aligning them with business strategies.

As a Complex Denials Consultant, you will counsel healthcare providers in disputes with insurance carriers, handle appeals, and ensure compliance with regulations.

As a Coding Integrity Specialist, you will conduct coding reviews, ensure proper reimbursement, collaborate with teams, and provide feedback on coding accuracy.

Lead forward-deployed process engineering for healthcare revenue cycle transformation: quantify ROI, design and optimize processes, mentor solution consultants, drive change management, monitor KPIs/SLAs, provide technical and operational leadership, and engage clients with data-driven insights. Up to 50% travel.

Lead assessments, design future-state workflows, and translate executive strategy into operational implementation for healthcare coding and revenue cycle. Drive process mapping, change management, KPI/SLA monitoring, training, and AI-enabled coding optimization while liaising between executives and operational teams.

Lead revenue cycle analytics for a new service line: design and maintain Snowflake SQL data models, build end-to-end Power BI reports, perform root-cause analyses, govern KPI definitions, QA datasets, and advise directors, executives, and clients to drive data-driven revenue cycle decisions.

Translate business requirements into implementation artifacts, document current and future-state workflows, and support end-to-end delivery of use cases. Assist with implementation plans, stakeholder communications, training, change management, go-live stabilization, KPI/SLA tracking, and post-implementation reviews. Maintain trackers, issue logs, and support continuous improvement. Role may require extensive travel to client sites.

Translate operational requirements into solution designs, process maps, and implementation plans. Conduct current-state assessments, support implementation and stabilization, define KPIs/SLAs, manage stakeholder communications, change management, and risk/issue mitigation while partnering with process engineers and cross-functional teams.

The role involves delivering business case quantification, optimizing processes, mentoring teams, and ensuring client satisfaction in healthcare revenue management.

Design and optimize consulting delivery processes, quantify use case ROI, lead and mentor consultants, develop roadmaps and change management, provide technical/product leadership, monitor KPIs/SLAs, and ensure continuous improvement. Role requires frequent customer engagement and significant travel (50%+).

Represent healthcare providers in disputes over workers' compensation, motor vehicle accident, third-party liability, and VA claims. Draft complex appeals and correspondence, apply state-specific statutes and lien laws, coordinate with external counsel, train recovery staff, and develop strategic legal and procedural approaches to recover denied claims efficiently.

Audit inpatient medical records to validate DRG assignments, document findings with supporting evidence, and recommend documentation improvements using ICD-10, AHIMA, and AHA coding guidance.

Conduct concurrent and retrospective reviews of inpatient records to improve clinical documentation and coding accuracy. Query physicians, assign working DRGs, perform mortality and PSI reviews, educate providers and CDI staff, collaborate with coders and quality teams, and assist onboarding/training of new CDI members.