Coding Integrity Specialist

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 combine a global workforce of revenue cycle professionals with an advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. Coding Integrity Specialist As our Coding Integrity Specialist, you will work with the Coding Integrity Manager and Director of Coding Operations to establish open lines of communication regarding potential coding quality concerns. Every day you will lead, coordinate, and perform coding quality reviews. To thrive in this role you must have strong analytical skills, the ability to comprehend and analyze large quantities of operational data, the ability to review complex medical records, and strong multi‑tasking and prioritization skills. Responsibilities Conduct complex coding reviews related to reimbursement, public reporting, and pay for performance. Collaborate with the CDI team, assisting with the resolution of documentation inconsistencies, DRG variances, and internal operations to ensure KPIs, SLA, RIS, and DNFB requirements. Ensure that the DRG or reimbursement accurately reflects the services and resources provided by the hospital to optimize the impacts of case mix index reporting. Collaborate with hospital/client leadership to validate proper coding for appropriate reimbursement for specific service lines and technology, assisting hospitals in determining the return on investment of that technology. Perform second‑level focused pre‑bill and post‑bill account reviews to ensure accurate coding, review for quality and risk (HAC, PSI, mortalities, Core Measures and CMS Initiatives) and escalation for final review, which may include approval for write‑off. Conduct complex 360 coding reviews that include identification and correction of coding, and trending for documentation, coding denials (medical necessity), billing, and charging issues. Evaluate coding accuracy and specificity to assist in preventing potential loss of revenue related to value‑based payment programs and public reporting. Provide education and feedback to coders and coding managers regarding coding corrections via automated notifications. Identify coding trends that require formal education by the R1 Education and Training team and work with integration and project management teams to test and provide feedback on updates to systems and mappings. Perform ad hoc Cloudmed DRG Validation Reviews or requests based on client‑specific needs. Required Skills Bachelor's or associate’s degree in HIM or a related field, or CCS credential. Minimum 5 years of inpatient coding experience. For this U.S.‑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. Competitive benefits package offered. R1 RCM Inc. (“the Company”) is dedicated to equal employment opportunity. The Company’s employment practices—including 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 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. The Company is also committed to a workplace free from harassment based on these 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 View phone number on click.appcast.io for assistance. #J-18808-Ljbffr R1 RCM