Jobs at R1 RCM

Process and maintain confidential medical and vital records: receive and verify birth certificate applications, retrieve and reconcile charts, prep/scan/index records, perform quality control, update databases and spreadsheets, and provide compassionate customer service to patients, providers, and payors.

Prepare, scan, index, and validate medical records and vital records; retrieve charts, reconcile missing documentation, enter/update secure databases, verify identification for birth certificates, and provide compassionate customer service while maintaining strict patient confidentiality.

Leads the global strategy, delivery, security, and operational performance of enterprise voice and digital workplace platforms. Owns client technology onboarding, regulatory and client issue resolution, organizational design, vendor oversight, budget management, and investment strategy. Builds a high-performing global organization, improves user and client satisfaction, ensures reliable platform deployment, and translates technical risks into business impact in a regulated healthcare-preferred environment.

Review denied authorization cases, evaluate documentation against evidence-based criteria, write clinical consultations, provide root-cause feedback to hospitals, and serve as a clinical resource for medical and case management staff across multiple specialties to improve authorization accuracy and claims submission.

Lead revenue cycle analytics for a new service line: design and maintain Snowflake SQL data models, build end-to-end Power BI reports, perform root-cause analyses, govern KPI definitions, QA datasets, and advise directors, executives, and clients to drive data-driven revenue cycle decisions.

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%+).

Lead IT governance, financial oversight, strategy and operations for enterprise IT. Own budgeting/forecasting, capital planning, PMO, metrics, communications, and employee engagement to ensure strategy alignment, delivery discipline, and measurable outcomes.

Conduct concurrent and retrospective reviews of inpatient records to improve clinical documentation and coding accuracy. Query physicians, participate in mortality/PSI reviews, educate providers and staff, collaborate with coders and quality teams, and assist onboarding of new CDI members. Maintain up-to-date knowledge of coding guidelines, CMS rules, and documentation best practices.

Lead teams to onboard, integrate, validate, and support clinical, financial, and revenue cycle data into R1 platforms. Manage medium-to-large implementation programs, partner with client IT and informatics, enforce interoperability standards (HL7, FHIR, X12, CCD/C-CDA), establish scalable processes and governance, resolve escalations, and collaborate cross-functionally to improve data quality, operational efficiency, and client outcomes.

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.

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.

Manage end-to-end provider enrollment and recredentialing for commercial, Medicare, and Medicaid payers. Maintain expirables, practice/billing locations, and NPPES records; complete CAQH attestations; submit and follow up on payer applications via portals; collaborate with providers and clients; meet monthly quality and productivity standards; assist with audits, training, and process escalation.

Audit inpatient medical records to validate DRG assignments, document findings with supporting evidence, and recommend documentation improvements using ICD-10, AHIMA, and AHA coding guidance.

Senior technical and business leader who defines analytics vision and architecture, builds scalable cloud data platforms and pipelines, drives AI/ML and self-service analytics, ensures governance and HIPAA compliance, and leads a multidisciplinary analytics team to deliver executive dashboards and data products that improve physician and revenue-cycle performance.

Lead and manage key healthcare provider client relationships for revenue cycle management. Align service delivery, translate performance metrics into action plans, identify risks and opportunities, promote best practices, and support revenue cycle transformation and team development to improve retention, outcomes, and satisfaction.

Conduct concurrent and retrospective reviews of inpatient records to improve clinical documentation and coding accuracy. Query physicians, assign working DRGs, perform mortality and PSI reviews, educate providers and CDI staff, collaborate with coders and quality teams, and assist onboarding/training of new CDI members.

Validate and triage clinical data across HL7, FHIR, and Databricks pipelines using SQL. Trace transformations end-to-end, identify and remediate data quality issues, partner with engineering/product/clinical teams, document findings, and support client go-lives to ensure clinically accurate, production-ready data.

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.

Lead setup and QA of client revenue-cycle data feeds, load and validate data, create standardized and ad-hoc reports, analyze results for operations and leadership, maintain health information system data models, implement data validation standards, and drive process improvements to accelerate implementations and improve data quality.