Outpatient Coding Quality Reviewer Job Springfield area,Illinois USA,Healthcare

At R1, we're transforming how healthcare works by combining nearly two decades of revenue cycle expertise with advanced technology, including analytics, AI, intelligent automation and workflow orchestration. We pair that technology with the irreplaceable expertise of our people to help hospitals, health systems and medical groups improve financial performance, simplify administrative complexity and create better experiences for patients and providers. All Together Better defines our culture and the way we work.

We're a diverse, global team united by a shared mission to make healthcare work better for all. Across technology, operations and support functions, our people bring deep expertise, empathy and ingenuity to the work we do. Here, collaboration fuels progress, adaptability sparks innovation and every voice can help shape what's next for R1 and the future of healthcare.

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

The Outpatient Coding Quality Reviewer is responsible for reviewing outpatient coded cases including but not limited to Ancillary, Emergency Department, Same Day Surgery, Observation, Wound Care, Professional Services, Interventional Cardiology and Interventional Radiology for coding completeness and accuracy. This position identifies potential coding and APC/payment opportunities, research appropriate guidelines to support recommended changes, and communicates the changes to the coder or quality reviewer involved on a timely basis.

The Outpatient Quality Reviewer provides expert coding advice to coding staff, global quality reviewers and relays needed coding educational topics to the Manager of Outpatient Coding Quality.

Here is what you will experience working as an Outpatient Coding Quality Reviewer:

Ensure coding accuracy and compliance by conducting quality reviews of outpatient records and validating CPT®, HCPCS, ICD-10-CM, modifier, and APC code assignments.
Serve as a trusted coding subject matter expert, providing audit feedback, coaching, and guidance that promotes coding excellence and consistency across teams.
Analyze audit results and identify trends to uncover opportunities for education, process improvement, and quality enhancement.
Partner with cross-functional teams, including Quality, Education, Denials, and Coding Operations, to resolve coding issues and support revenue integrity initiatives.
Stay current on industry regulations and coding guidelines, ensuring compliance with CMS, AHA, AMA, and other regulatory requirements.
Drive continuous improvement through collaboration, training, and process optimization while maintaining exceptional accuracy, productivity, and performance in a remote environment.

Required Skills:

High School diploma, GED or equivalent
Required one or more active certification(s): RHIT, RHIA, COC, CCS-P or CCSA
Minimum of seven (7) years of hospital outpatient coding experience (including Ancillary, Emergency Department, Same Day Surgery, Observation, Wound Care, E/M Professional service, Interventional Cardiology, and Interventional Radiology)

Preferred

Skills:

Bachelor's or Associate Degree

For this US-based position, the base pay range is $28.24 - $40.21 per hour. Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

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