Denials Rules Associate

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 - Rules Associate, 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, 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. 

Here’s what you will experience working as a Denials Rules - Rules Associate: 

• Create mappings based on payer, CARC/RARC codes, and CPT codes to drive workflow decisions and assist with automating processes and driving efficiency improvements. 

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

• Work collaboratively with internal project teams to develop and optimize workflows, as well as to build and validate data mappings.  

• Develop skills to troubleshoot complex code and ability to debug effectively. 

• Work with Product, RPA and IT teams to communicate and develop workflow and automation needs. 

• Identify and implement opportunities for optimizing internal processes through automation using Spark SQL and Python. 

• 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. 

• Perform trending and analysis on 835/7 data, client extracts, and other data sources. 

• Ability and understanding to effectively assist database administrators with SQL Server maintenance and updates as it pertains to our system. 

• Use PowerBI to create clear and accurate reports for internal team members. 

Required Skills: 

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

• Strong conceptual, quantitative, and qualitative analytical skills. 

• Team-oriented and collaborative in their working style. 

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

• A focus on operational process improvement to enhance organizational efficiency. 

• Intermediate+ level experience with SQL programming. 

• Experience with ETL processes in a SQL environment. 

Desired Qualifications: 

• Experience working in/with Databricks, Snowflake, PowerBI, Python, SSMS 

• Familiarity with 837/835 transaction sets, CARC/RARC codes 

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

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

• Proficiency in using AI and Large Language Models (LLM) for business use cases 

• Proficient in Microsoft Office, especially Excel (Access is a plus)