Jobs at R1 RCM

Leads multiple enterprise programs and cross-functional workstreams, coordinating teams, tracking progress, managing risks, communicating with customers and senior leaders, and resolving roadblocks. Supports data acquisitions, customer onboarding, corporate initiatives, and AI-driven process improvements while partnering with domestic and international teams.

Analyze denied healthcare claims to identify clinical, coding, and process-related root causes. Develop problem statements, validate medical terminology and coding accuracy with revenue cycle teams, assess financial impact, and support corrective actions that reduce preventable denials and revenue loss. The role requires experience in denials and performance management, strong critical thinking, and clear stakeholder communication.

Leads enterprise revenue cycle analytics strategy, product roadmaps, and analytics delivery across hospital billing, professional billing, clients, and shared services. Builds an analytics organization, standardizes KPIs and data practices, delivers dashboards and self-service tools, and partners with Product, Technology, and Data Engineering to advance automation and AI-enabled solutions. Advises executives and customers on financial and operational improvement opportunities.

Translate business requirements into implementation artifacts, document current and future-state workflows, and support end-to-end delivery of use cases. Assist with implementation plans, stakeholder communications, training, change management, go-live stabilization, KPI/SLA tracking, and post-implementation reviews. Maintain trackers, issue logs, and support continuous improvement. Role may require extensive travel to client sites.

Reviews and interprets inpatient medical records, claims documentation, and coding information to appeal denied or underpaid claims. Applies clinical judgment to DRG downgrades and clinical validation reviews, drafts persuasive appeal letters, recommends coding changes using ICD and procedural coding guidelines, and meets compliance deadlines in a remote, production-driven environment.

Manage sales compensation, commission administration, territory planning, quota setting, and sales-planning governance. Design and model incentive plans, allocate quotas, balance territories, resolve commission issues, maintain accurate Salesforce and Workday data, and oversee related systems, controls, reconciliations, and documentation. Partner cross-functionally with Sales, Finance, HR, Legal, Accounting, and leadership to ensure financially sustainable plans, accurate payouts, effective coverage, and timely annual planning execution.

As a Senior Product Manager, you will oversee AI analytics product development, prioritize initiatives, communicate with stakeholders, and manage the product roadmap while ensuring timely delivery of features and aligning them with business strategies.

Lead forward-deployed process engineering for healthcare revenue cycle transformation: quantify ROI, design and optimize processes, mentor solution consultants, drive change management, monitor KPIs/SLAs, provide technical and operational leadership, and engage clients with data-driven insights. Up to 50% travel.

Lead assessments, design future-state workflows, and translate executive strategy into operational implementation for healthcare coding and revenue cycle. Drive process mapping, change management, KPI/SLA monitoring, training, and AI-enabled coding optimization while liaising between executives and operational teams.

Supports healthcare data interface and integration projects under senior guidance. Assists with implementation tasks, data extract solutions, troubleshooting, project organization, and client go-lives. Uses basic coding and SQL skills to review data and support integration workflows. Communicates project progress and risks, follows structured implementation processes, participates in after-hours go-live support, and provides periodic on-call coverage.

Execute complex healthcare interface and data exchange projects using Rhapsody or equivalent interface engines. Troubleshoot client integration issues, manage implementation resolution and optimization, validate data flows, support go-lives, and collaborate with internal and external stakeholders. The role requires healthcare data exchange knowledge, basic coding and SQL skills, strong communication, independent work, and periodic on-call and after-hours support.

Review denied authorization cases, evaluate documentation against evidence-based criteria, write clinical consultations, provide root-cause feedback to hospitals, and serve as a clinical resource for medical and case management staff across multiple specialties to improve authorization accuracy and claims submission.

The role involves delivering business case quantification, optimizing processes, mentoring teams, and ensuring client satisfaction in healthcare revenue management.

Design and optimize consulting delivery processes, quantify use case ROI, lead and mentor consultants, develop roadmaps and change management, provide technical/product leadership, monitor KPIs/SLAs, and ensure continuous improvement. Role requires frequent customer engagement and significant travel (50%+).

Represent healthcare providers in disputes over workers' compensation, motor vehicle accident, third-party liability, and VA claims. Draft complex appeals and correspondence, apply state-specific statutes and lien laws, coordinate with external counsel, train recovery staff, and develop strategic legal and procedural approaches to recover denied claims efficiently.

Audit inpatient medical records to validate DRG assignments, document findings with supporting evidence, and recommend documentation improvements using ICD-10, AHIMA, and AHA coding guidance.

Review payer peer-to-peer authorization denials, evaluate documentation and appropriateness of requested admission status/procedure/care setting, engage with payer medical directors, provide written case analyses across specialties, and serve as a clinical resource to resolve documentation and utilization issues.