R1 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 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
As our Complex Denial Consultant, you will represent healthcare providers in their disputes with medical insurance carriers and managed care organizations at all stages of the administrative appeals process.
Every day you will, handle contract review and appeal template development based on contractual provisions and state and federal law as applicable, writing appeals and letters to insurance companies to resolve denials, and review of high balance or complex accounts.
To thrive in this role you must maintain a foundational understanding Commercial, Governmental, Managed Care, and ERISA regulations regarding payment, coverage, conditions of participation, and other relevant topic.
Responsibilities
Assist recovery staff in pursuing appeals, including the development of new and innovative legal and procedural arguments and tools.
Draft complex and contractual appeals and letters to insurance companies.
Review and apply client contract language and rates as necessary to resolve denied claims.
Utilize payer provider and administrative manuals to dispute denied claims.
Contact provider representatives or higher-level resolution units to resolve complex claim and appeal issues.
Represent clients during Administrative Law Judge hearings as needed.
Assist with the training of recovery staff team members and provide necessary feedback as requested by management.
Apply provider specific reimbursement methodologies, payment policies and provider contracts to confirm payment in full.
Meet performance standards and goals set by management.
Administrative duties or projects as assigned by a Senior Complex Denial Consultant or another member of leadership.
Follow all HIPAA guidelines.
Other duties may be assigned.
Required Qualifications
Law degree from an accredited college or university
Barred in one state or must be bar eligible within 6 months of graduation
For this US-based position, the base pay range is $60,000.
00 - $86,842.
00 per year .
Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.
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.
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