R1 RCM

• Audit inpatient cases for DRG validation • Review inpatient medical records for validation of DRG assignment • Provide detailed rationale and supporting evidence for the recommendation and findings • Utilize industry-recognized references to support their review findings, such as the ICD-10 Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinics • Evaluate claim reimbursement potential based on coding assignment

• Review payor peer-to-peer cases for authorization status • Evaluate documentation for admission status, procedure, and care setting • Advise clients on appropriateness of requests based on documentation • Engage with payor medical directors regarding authorization status • Provide written analysis of cases and perform reviews across specialties • Serve as a clinical resource for medical and case management staff

Role Description As the Contingent Workforce Specialist, you will be involved in building out a new Contingent Workforce Program at R1. You will manage timely and efficient onboarding through offboarding lifecycle activity of internally managed the Contingent Workforce program, reporting to the Director of the Program. On a daily basis, this specialist will oversee and be accountable for the successful VMS lifecycle management activities for the Contingent Workforce program. - Effectively manage all contractor lifecycle activity within the VMS Technology to ensure speed and quality control. - Work with the Governance team on ensuring lifecycle activities are handled accurately. - Provide guidance and support to all R1 Managers within the contractor lifecycle. - Ensure the program meets performance standards and proactively identify issues. - Foster positive relationships with R1 Supplier Community. - Work collaboratively with the Program Manager and serve as second in command in their absence. - Support compliant contingent labor processes. - Provide support and distribute operational reports as necessary. - Support Program Manager in program expansion activities. - Support P/M in the preparation of contingent labor data and results to management quarterly. Qualifications - 3 or more years of applicable experience; MSP, Contingent Labor, VMS, Recruitment, Labor Fulfillment. - Basic knowledge of legal and regulatory compliance related to contract labor. - Strong organizational skills. Requirements - For this US-based position, the base pay range is $48,131.00 - $81,225.49 per year. - This job is eligible to participate in our annual bonus plan at a target of 5.00%. Benefits - Opportunity to constantly learn and collaborate across groups. - Chance to contribute, think boldly, and create meaningful work. - Competitive benefits package.

• Examine patient billing records, claims, remittance advice, and supporting documentation to ensure accuracy, completeness, and compliance with client and payer requirements. • Navigate multiple Patient Accounting and revenue cycle systems to research accounts, update information, document account activity, and support billing and collections processes. • Send, receive, track, and organize healthcare and billing-related documents via fax while ensuring timely processing and proper record retention. • Handle inbound and outbound phone communications with patients, insurance representatives, healthcare providers, and internal stakeholders to resolve account inquiries and obtain necessary information. • Utilize Microsoft Excel to enter, review, track, and reconcile account data, generate reports, and identify discrepancies requiring follow-up. • Safeguard Protected Health Information (PHI) by adhering to HIPAA regulations, organizational policies, and security protocols when handling patient records, communications, and billing information. • Complete clerical and administrative tasks including document management, correspondence, account research, data entry, and other activities that support efficient client operations and service delivery.

• Develop and deliver CDI education for Clinical Documentation Specialists and physicians • Analyze documentation and coding trends to identify opportunities for quality improvement • Partner with CDI, coding, compliance, and operational leaders to drive documentation excellence and workflow standardization • Create and deliver engaging education programs on clinical documentation, coding guidelines, regulatory standards, and CDI best practices • Provide coaching, mentoring, onboarding, and ongoing development for CDI staff and physicians • Monitor CDI metrics, conduct audits, analyze trends, and recommend performance improvement initiatives • Collaborate with coding, compliance, and operational teams to ensure documentation supports accurate coding, reimbursement, and regulatory compliance • Support day-to-day CDI operations and assist with complex documentation scenarios as business needs require.

• Report Creation: Design and deliver recurring Power BI and ad-hoc Excel reports to stakeholders. • Analysis: Analyze complex datasets to identify trends, patterns, and anomalies. • Support strategic initiatives with data-driven recommendations. • Automation & Process Improvement: Utilize development tools such as SQL Server, Snowflake, Databricks, and Git. • AI Agent Design for Reporting: Design and develop AI-powered agents to automate insight generation and reporting workflows. • Data Modeling: Design and optimize large-scale data models to support complex analytics and reporting requirements. • Quality Assurance: Establish and enforce validation standards for data integrity and report accuracy.

• Develop and execute a strategy that aligns with company objectives to rapidly build brand awareness and drive new revenue within the assigned geography • Meet or exceed monthly, quarterly and annual goals • Accurately forecast attainment on a monthly, quarterly and annual basis • Document sales activity through CRM automation tool (Salesforce) • Assess areas of personal and professional development, which would enable greater individual, as well as team, sales success • Possess a strong/effective presence with hospital and health systems' various leadership teams and executives, including the C-suite; Ability to navigate, coordinate and influence internal and external customers at all levels of the organization • Demonstrated ability to collaborate in a team selling environment, to identify, pursue and capture new client relationships.

• Provide strategic leadership for client-facing operations • Cultivate and maintain client relationships • Drive client satisfaction and optimize service delivery processes • Conduct necessary analytics to communicate performance to clients • Support projects to improve operational performance metrics • Mentor and guide managers and analysts for scalable processes

Role Description If you have experience in insurance customer service, medical claims, or healthcare call centers, this is your opportunity to take the next step in your career. Join a team where your ability to resolve billing and insurance questions directly improves the patient experience while building deeper revenue cycle expertise. As a Patient Solutions Representative II, you will work in a high-volume healthcare call center environment, supporting patients with billing, insurance, and account-related questions. - Resolve questions related to medical billing, insurance coverage, claims, EOBs, and account balances - Deliver high-quality customer service through inbound and outbound calls in a high-volume environment - Support patients with payment plans and financial questions - Achieve first call resolution and meet call center performance metrics - Use EMR systems (Epic, Cerner, Meditech) to research and resolve issues - Maintain HIPAA compliance and accurate documentation - Navigate multiple systems while managing high call volume Qualifications - 1+ year of experience in a customer service or call center role - Experience in health insurance, payer customer service, or medical billing/claims (highly preferred) - Ability to explain insurance benefits, claims, and EOBs clearly - Experience handling high call volume and fast-paced environments - Strong attention to detail and ability to multitask across systems - Familiarity with EMR systems (Epic, Cerner, etc.) is a plus Ideal Backgrounds - Health insurance customer service (Optum, UnitedHealthcare, Anthem, Aetna, BCBS) - Medical claims or billing support roles - Revenue cycle or patient financial services - Healthcare contact center / call center environments Benefits - Build deeper expertise in revenue cycle and patient financial services - Work in a structured, metrics-driven call center environment with growth opportunity - Make a direct impact on patient experience and financial outcomes - Competitive benefits package Company Description 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.

• Provide exceptional financial counseling support to patients • Meet with patients to discuss payment options • Verify insurance eligibility and explain benefits • Assist with Medicaid and financial assistance applications • Collaborate with care teams and revenue cycle departments