Coding Quality Associate Jobs

Location: Remote, USA

Shift: Monday-Friday, Flexible shifts will fall between 3:00AM-11:00PM Eastern time, 8.5 hour shifts with a 30 minute lunch.

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, patient’s 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 Coding Quality Assocaite will be responsible for reviewing inpatient coded cases for coding completeness and accuracy. This person will identify potential coding and DRG errors, researches appropriate guidelines to support recommended changes, and communicates the changes to the coder involved on a timely basis. The Reviewer provides expert coding advice to coding staff and relays needed coding educational topics to the Regional Manager, IP Coding Quality. This role will report to the Regional Manager of Inpatient Coding Quality. In this role, the successful candidate will conduct daily pre-bill review of cases flagged by the PwC SMART coding quality monitoring software tool, maintain required productivity standards and high-quality results.

Responsibilities:

• Assists with training of new auditors
• Contributes to the reduction of the hospital's and Company’s coding compliance risks and contributes to the Company’s revenue enhancement goals
• Maintains both a high productivity rate and a high accuracy rate in accordance with established auditing standards
• Maintains an open dialogue and a good working relationship with team members in order to advance the mission and objectives of the hospitals and R1
• Assists with other audits and duties as requested
• Follows, and maintains up-to-date knowledge of, industry coding and documentation guidelines (e.g., Official ICD-10 Coding and Billing Guidelines, Coding Clinic advice, R1 and Ascension coding policies and procedures, and AHIMA/ACDIS Query Guidelines) so as to maintain system-wide coding consistency and remain in compliance with governmental and other regulatory guidelines
• Communicates audit findings with coders in a timely manner and supports the teams in effectively and efficiently addressing and resolving local coding issues
• Audits records as defined in the coding quality review plan
• Reports to, and works with, the Regional Manager to identify improvements in the audit software tool, workflow processes and flag management; and assist with evaluation and testing of audit applications and updates as needed
• Perform retrospective coding quality reviews as requested
• Serves as an inpatient coding expert & resource for the coding teams and other departments
• Works with the Regional Manager to identify areas of educational need based on audit results
• Review cases flagged by the coding quality software on a daily basis for multiple hospitals, including validating the completeness of documentation, identifying diagnoses and procedures that have been missed, proposing physician queries, and ensuring the accuracy of diagnoses, procedures, POA, discharge disposition and DRG assignment
• Work with the hospital’s CDI team to address and resolve documentation issues
• Assists with compilation, generation and analysis of data for results reporting and performance Improvement initiatives

Required Qualifications:

• Must have proficient MS Office computer skills, specifically in Excel and knowledge of various coding software/platforms and EMRs
• RHIT, RHIA or CCS credential is required
• A minimum of seven (7) years of hospital inpatient coding experience is required
• Must be detail-oriented and have the ability to work independently and maintain a high productivity rate and coding accuracy rate
• Ability to interact with other employees through effective communication Must be a self-starter
• In-depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required
• Expert and up-to-date knowledge of industry Official Coding and Reporting Guidelines along with CMS and other agency directives for ICD-10 coding
• Extensive knowledge of ICD-10-CM/PCS classification system and MS- DRG and APR-DRG methodologies is required

Desired Qualifications:

• Training in hospital Clinical Documentation Improvement is preferred
• Two (2) years of inpatient coding audit experience is preferred
• Experience as a Coding Consultant with a consulting firm is preferred
• Experience in a large (> 500 beds) hospital or multi-hospital health system is preferred

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 package. To learn more, visit: r1rcm.com.

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 package including:

• Comprehensive Medical, Dental, Vision & RX Coverage
• Parental Leave
• 401K with Company Match
• Company-Paid Life Insurance, Short-Term Disability & Long-Term Disability
• Paid Time Off, Volunteer Time & Holidays
• Tuition Reimbursement

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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