Rules Architect

R1 RCM Inc. 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 a 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.

The Rules Architect will be responsible for building and maintaining the Charge Capture rule library.

In order to be successful in this role, the Rules Architect will need a deep understanding of healthcare data, coding and charging practices along with a problem-solving mindset and desire to work collaboratively within and across departments.

Responsibilities:

• Apply a deep understanding of healthcare data to solve problems for internal and external stakeholders 
• Assist other Rule Architects in maintaining of the existing rules library, modification of existing rules and net new rule creation/new rule ideas/concepts 
• Assist other Rule Architects in Manual Targeting/High Volume Review as assigned
• Analyze client data for trends in billing and coding
• Analyze rule performance and identify where rule enhancement or refinement is needed
• Make Category and Rule edits based on auditor feedback
• Review rules inflowed and removed by auditors or client rejections to ensure the appropriate actions were taken
• Create client specific rules and/or rule refinement based on auditor requests and data analysis
• Contribute to meeting content creation based on QA findings and provide education in meetings as needed

Required Qualifications:

• High School Diploma
• 3+ years of experience in healthcare industry (eg: Hospital Coding, Billing, Auditing, Chargemaster, healthcare analytics)
• Knowledge of coding with CPT/HCPCS/ICD10 diagnosis and PCS
• Working understanding of hospital revenue cycle process
• Understanding of contracts and reimbursement methodology
• Excellent oral and written communication skills
• Proficiency in Microsoft Office products; excellent computer skills

Desired Qualifications:

• Associate’s degree or higher
• Experience querying, validating, and analyzing data in SQL or a similar language
• Medical Coding Certification – CCS, CPC, CPC-H
• Knowledge of medical terminology, anatomy, and physiology
• Knowledge of healthcare applications and systems
• Strong conceptual, as well as quantitative and qualitative analytical skills
• Ability to work well independently and in a team
• Ability to prioritize, multi-task and work in a fast-paced environment
• Excellent organizational skills and strong attention to detail
• Understanding of contracts and reimbursement methodology
• Positive attitude

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

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.  

To learn more, visit: R1RCM.com

Learn more about Benefits at R1

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

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.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent

To learn more, visit: R1RCM.com

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