Outpatient Quality Reviewer

R1 RCM•Remote, IL, IL

1d•$28 - $40•Remote

About The Position

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 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.

Requirements

High School diploma, GED or equivalent
Required one or more active certification(s): RHIT, RHIA, COC, CCS-P or CCS
A 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) is required.

Nice To Haves

Bachelor's or Associate Degree

Responsibilities

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.