Jobs at R1 RCM

Reviews inpatient medical records concurrently and retrospectively to identify documentation gaps, support accurate coding and DRG assignment, and improve severity-of-illness and reimbursement outcomes. Queries physicians for clarification, conducts mortality and PSI reviews, educates providers and CDI staff, collaborates with coders and quality teams, and maintains compliance with coding, CMS, and regulatory requirements.

Reviews denied payer authorization cases to assess admission status, procedures, care settings, documentation, and evidence-based clinical criteria. Conducts peer-to-peer discussions with payer medical directors, provides timely written case analyses, advises client facilities, and resolves documentation and utilization issues. Serves as a clinical resource across multiple specialties while working independently in a remote environment.