Teams at R1 RCM

Review outpatient clinical documentation to accurately assign ICD-10-CM, HCPCS and CPT-4 codes; perform retrospective quality audits; identify and correct coding errors; support reporting, education, and performance improvement; maintain coding guideline knowledge and compliance.

Provide patient financial counseling for transplant patients: verify insurance eligibility, explain benefits and out-of-pocket costs, assist with Medicaid and financial assistance applications, document interactions, collaborate with care and revenue cycle teams, and support payment solutions with empathy and accuracy.

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.