Clinical Coding Reviewer at R1 RCM in Boise, Idaho, United States Job Description 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.
As our Clinical (Coding) Reviewer, you will review and interpretation of medical records to draft appeals of denied and underpaid claims.
Every day you will, review medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes.
To thrive in this role you must draft appeal letters based on clinical judgment and knowledge and making coding change suggestions to our clients based on ICD-9 / 10 CM & PCS, CPT, HCPCS, NCCI guidance, and Coding Clinic.
Responsibilities : + Familiarity with and ability to identify different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial / approval letters.
- Review and interpret medical records to appeal denied and underpaid claims. + Apply clinical judgment and knowledge for DRG downgrades performed as a result of a Clinical Validation Review by an insurer or third-party auditor.
- Draft appeal letters that are well written, logically structured, and persuasive, utilizing ICD-9 / 10 CM & PCS, CPT, HCPCS, NCCI guidance, and Coding Clinic.
- Handle rush and high balance cases in accordance with office policy for prioritization. + Ensure that all appeals are completed timely and sent by the specified deadline.
- Required Qualifications : + Licensure as a Registered Nurse (RN) or Licensed Practical Nurse (LPN / LVN) + Active CPC or CCS certification;
or, in lieu of active coding certification, a minimum of 2 years of experience in a Clinical Documentation Improvement (CDI) position + Direct experience in medical record reviews / audits For this US-based position, the base pay range is $60,000.
00 - $86,842.00 per year . Individual pay i To view full details and how to apply, please login or create a Job Seeker account