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. 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.

Description

We are looking for Associates to join the Underpayments division of our Rules and Contracts team. Work on this team is divided into the following groups: Global Rules, Medicaid, Comprehensive Commercial and Denials. These teams are primarily responsible for underpayment opportunity generation (I.e., risk finding), and each team has a unique approach to the challenge. On the Comprehensive Commercial team, you will develop expertise in payer contract structures, contract modeling and contract-based rules writing. On the Medicaid team, you will specialize in Medicaid reimbursement structures (APR-DRG pricing, EAPG pricing, etc.), state-specific billing and coding requirements, and Medicaid-specific rule writing. On the Global Rules team, you will refine, optimize and create rules that can be executed on individual databases or across all databases in an automated rules system. On the Denials team, you develop a deep understanding of payer denials behavior and how to best target Denials-based opportunities by creating rules and automated actions.

RESPONSIBILITIES (including but not limited to…)

Comprehensive Commercial:

• Critically analyze commercial payer contracts for underpayment opportunities;

• Model commercial contracts and execute pricing in IPAM and OPAM;

• Develop and run targeted, contract-based rules to pinpoint underpayment opportunities or trend/analyze data to flag/develop new underpayment opportunities, which includes SQL development and verification of results;

• Collaborate with Global Rules team to search for new pockets of opportunity across clients;

• Maintain strong lines of communication with project teams, responding to feedback and requests.

Medicaid:

• Price, trend, analyze, and research Medicaid volume to find underpayment opportunities;

• Create and validate new risk opportunities, which includes SQL development and verification of results;

• Build state-specific Medicaid expertise;

• Build pricers based off a state’s Medicaid reimbursement, working in tandem with East/West counterparts to continue state expansion;

• Evaluate Medicaid workflows, implement process improvements, and create deliverables;

• Strategically communicate results back to project teams upon completion of a review.

Global Rules:

• Automate the execution of global and project-specific rules by converting them into a new framework for execution, which includes SQL development and verification of results;

• Manage and maintain rules by assessing hit rate (conversion to inflow), collectability, and complexity;

• Create new rules based on changing legislation, trends across clients, and collaboration with Comprehensive Commercial team;

• New client intake: review commercial contract structures and client data to efficiently assess likely underpayment opportunities for new R1 RCM Underpayment clients.

Denials:

• Develop and automate the execution of global and project-specific rules, which includes SQL development and verification of results;

• Manage and maintain rules by assessing hit rate (conversion to inflow), collectability, and complexity;

• Create new rules based on denials trends across clients and collaboration with Service Line Operational teams;

• Maintain strong lines of communication with Operational teams, responding to feedback and requests;

• Evaluate operational workflows, implement process improvements and increase efficiencies;

• Perform trending and analysis on large data sets including 837/835 data, client extracts, and other data sources, using Excel, Access and SQL;

REQUIRED QUALIFICATIONS

• Bachelor’s degree or 2+ years experience with data analytics;

• Exceptional analytical skills;

• Self-starter who is eager to learn, and can work both independently and in a team environment;

• Detail-oriented, with demonstrated organizational skills and the ability to manage time effectively, prioritize tasks;

• Demonstrated interpersonal skills to work effectively in a team environment with internal stakeholders;

• Ability to build trust and confidence with internal clients through effective interaction, training, and collaboration.

PREFERRED QUALIFICATIONS

• SQL query writing experience;

• 2+ years experience with hospital billing, and/or revenue cycle.

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

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.