Jobs at R1 RCM

Reviews hospital accounts to identify and validate underpayments, confirms expected reimbursement, researches payer and account details, diagnoses root causes, and determines resolution actions. Documents findings to support appeals, collaborates with support teams, and meets production, accuracy, and efficiency benchmarks while using patient accounting systems, payer portals, and proprietary software.

Identify and evaluate AI opportunities by analyzing large healthcare datasets, assessing value vs. feasibility, uncovering inefficiencies, and translating insights into actionable recommendations. Collaborate with stakeholders to prioritize use cases, contribute to AI project roadmaps and design specifications, and present findings to operational and technical audiences to drive implementation and ROI.

Leads cybersecurity governance, risk, and compliance programs, with ownership of third-party cyber risk, customer security assessments, risk exceptions, and the cyber risk register. Manages a geographically distributed team, matures GRC processes, drives automation, partners with internal and external stakeholders, and reports risk trends and recommendations to senior leadership. Requires extensive cybersecurity experience, people leadership, customer-facing skills, and experience building or improving third-party risk capabilities.

Audit inpatient medical records for DRG validation and documentation improvement. Review accounts in proprietary software and client EMR systems, validate DRG assignments, and provide detailed rationale supported by ICD-10 guidelines, AHIMA standards, compliant-query practices, and AHA Coding Clinics.

Oversee day-to-day revenue cycle engagements for hospitals and health systems, communicate performance to client and executive stakeholders, support operational improvements, develop remediation plans, and execute initiatives that improve metrics, KLAS scores, NPS, and client outcomes. Translate operational insights into best practices, standardized analyses, and reusable client presentation templates.

Manages regional hospital coding operations, including team performance, productivity, quality targets, service-level agreements, workflow issues, and process improvement. Conducts coding performance reviews, coaches staff, addresses quality and compliance issues, leads resolution plans, and collaborates with customers, leadership, and quality review teams. Requires an AHIMA or AAPC coding certification and healthcare revenue cycle management experience.

Audits acute inpatient medical records to validate Diagnosis Related Group assignments and documentation improvement opportunities. Reviews accounts in proprietary software and client EMR systems, provides detailed rationales and supporting evidence, and uses ICD-10 guidelines, AHIMA standards, compliant querying practices, and AHA Coding Clinics to support findings. Requires current AHIMA credentials and at least three years of ICD-10 auditing and DRG reimbursement experience.

Leads strategic initiatives for an AI-driven healthcare revenue cycle platform. Coordinates product, engineering, operations, finance, marketing, and commercial stakeholders; manages objectives, roadmaps, backlogs, releases, leadership forums, and executive communications. Translates complex technical and business concepts into compelling presentations and recommendations while identifying risks, resolving obstacles, and supporting product adoption, go-to-market execution, and market positioning.

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

Reviews and interprets inpatient medical records, claims documentation, and coding information to appeal denied or underpaid claims. Applies clinical judgment to DRG downgrades and clinical validation reviews, drafts persuasive appeal letters, recommends coding changes using ICD and procedural coding guidelines, and meets compliance deadlines in a remote, production-driven environment.

Manage sales compensation, commission administration, territory planning, quota setting, and sales-planning governance. Design and model incentive plans, allocate quotas, balance territories, resolve commission issues, maintain accurate Salesforce and Workday data, and oversee related systems, controls, reconciliations, and documentation. Partner cross-functionally with Sales, Finance, HR, Legal, Accounting, and leadership to ensure financially sustainable plans, accurate payouts, effective coverage, and timely annual planning execution.

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.

Supports healthcare data interface and integration projects under senior guidance. Assists with implementation tasks, data extract solutions, troubleshooting, project organization, and client go-lives. Uses basic coding and SQL skills to review data and support integration workflows. Communicates project progress and risks, follows structured implementation processes, participates in after-hours go-live support, and provides periodic on-call coverage.

Execute complex healthcare interface and data exchange projects using Rhapsody or equivalent interface engines. Troubleshoot client integration issues, manage implementation resolution and optimization, validate data flows, support go-lives, and collaborate with internal and external stakeholders. The role requires healthcare data exchange knowledge, basic coding and SQL skills, strong communication, independent work, and periodic on-call and after-hours support.

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.

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.