Clinical Appeals & Denials Manager

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 our Clinical Appeals and Denials Manager, you will serve as an expert on clinical appeals and denials management. Every day you will support client hospitals where claims were denied or underpaid by governmental contractors, third-party auditors, or other payers. You will oversee the Clinical Appeals staff, strategically manage the appeals inventory and workflow, and continuously refine efficiencies through process improvement. The Manager is responsible for ensuring client satisfaction and department goals are met and maintained. To thrive in this role, you must have prior leadership experience in medical record reviews or clinical denial management.

Here’s what you will experience working as a Clinical Appeals & Denials Manager:

Serve as a leader and mentor to Clinical Appeals Supervisors and staff.

Ensure client satisfaction with the quality of appeals work and response times.

Assist in the preparation of client feedback and onboarding.

Maintain and monitor all department KPIs including, but not limited to quality of work, production measures, QA, turnaround times, and success rate.

Successfully collaborate with recovery leadership and operations support to escalate trends, challenges, and process improvement opportunities.

Required Skills:

Registered Nurse (active or inactive in good standing and able to be reinstated within 6 months of employment)

For this US-based position, the base pay range is $92,143.00 - $148,792.00 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package. (http://go.r1rcm.com/benefits)

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.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent (https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf)

To learn more, visit: R1RCM.com

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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.

Headquartered near Salt Lake City, Utah, R1 employs over 29,000 people globally and is traded on the Nasdaq stock exchange under the symbol “RCM.”