Senior Rules Architect, Denials

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.   

As a Denials Rules - Senior Rules Architect, you will help the company by expanding the scope, accuracy and impact of Denials Rules across several Service Lines.  Every day, you will work with our internal stakeholders and Rules team to support Operations in their ability to drive workflow decisions, process automation and efficiency improvements.  You will need a strong understanding of our technical systems (Databricks – Spark SQL), an analytical and process improvement mindset, and the ability to effectively manage multiple projects at once. 

To thrive in this role, you must be comfortable effectively communicating with all levels, be able to quickly understand complex scenarios, and collaboratively drive change management. This position needs someone that also thrives in combining technical SQL skills and critical thinking with project-based analytical skills. The successful candidate must demonstrate organizational skills and the ability to manage time effectively and prioritize tasks independently. 

Responsibilities:  

• Build relationships and collaborate with multiple service lines, business leaders, and the Rules team to expand the impact of Denials Rules and drive change through efficiency and process improvement 

• Quickly establish trust and confidence with stakeholders through effective communication, proactive collaboration, and results delivery 

• Be a role model, teacher, coach, mentor, and support system for the Senior/Rules Associates  

• Demonstrate a trailblazer and innovative mindset that is not afraid to think outside of the box and pressure-test existing processes to seek out new and improved ways of optimizing the business 

• Ability to effectively track and manage various projects across the team that can span a variety of project types from technical to strategic   

• Dedicate time to seeking out opportunities to expand scope and impact across new and existing service lines, followed by developing a strategic plan and working with relevant stakeholders to implement 

• Work with the Denials Rules team to monitor and analyze rule performance and identify action-based insights that the team can then implement 

• Conduct macro-level and micro-level data analysis to support a variety of strategic solutions based on stakeholder feedback and priorities to target proactive rule creation, refinement, and optimization 

• Develop the ability to build and improve PowerBI reports, including a robust understanding of R1’s data environments (e.g., Snowflake, Databricks) that serve both internal and external initiatives 

• Identify and implement opportunities to optimize internal processes through Spark SQL and Python automation. Partner with the Denials Rules technical team to build out new and improved solutions 

• Develop skills to troubleshoot complex code and ability to resolve bugs in rules engine 

• Review various data sets for inconsistencies, errors, or omissions, as well as work with internal teams to import, cleanse and leverage data fields 

Required Skills:  

• Strong communication skills and ability to build relationships and collaborate with others 

• Detail-oriented, with demonstrated organizational skills and the ability to manage time effectively, and prioritize tasks 

• Advanced conceptual, quantitative, and qualitative analytical skills 

• Self-starter and ability to quickly learn new skills and programs 

• Intermediate+ level experience with SQL programming 

• Experience with ETL processes in a SQL environment 

• Understanding of ICD-10, HCPCS/CPT coding, medical terminology 

• Understanding of EOB and hospital billing form (UB-04) requirements 

• Proficient in Microsoft Excel (experience using Microsoft Access is a plus)