[Hiring] Outpatient Quality Reviewer @R1 RCM

Role Description

The Outpatient Quality Reviewer is responsible for reviewing outpatient coded cases including but not limited to:

• Ancillary
• Emergency Department
• Same Day Surgery
• Observation
• Wound Care
• Professional Services
• Interventional Cardiology
• Interventional Radiology

This position identifies potential coding and APC/payment opportunities, researches appropriate guidelines to support recommended changes, and communicates the changes to the coder or quality reviewer involved on a timely basis. The Outpatient Quality Reviewer provides expert coding advice to coding staff, global quality reviewers and relays needed coding educational topics to the Manager of Outpatient Coding Quality.

Here is what you will experience working as an Outpatient Quality Reviewer:

• Ensure coding accuracy and compliance by conducting quality reviews of outpatient records and validating CPT®, HCPCS, ICD-10-CM, modifier, and APC code assignments.
• Serve as a trusted coding subject matter expert, providing audit feedback, coaching, and guidance that promotes coding excellence and consistency across teams.
• Analyze audit results and identify trends to uncover opportunities for education, process improvement, and quality enhancement.
• Partner with cross-functional teams, including Quality, Education, Denials, and Coding Operations, to resolve coding issues and support revenue integrity initiatives.
• Stay current on industry regulations and coding guidelines, ensuring compliance with CMS, AHA, AMA, and other regulatory requirements.
• Drive continuous improvement through collaboration, training, and process optimization while maintaining exceptional accuracy, productivity, and performance in a remote environment.

Qualifications

• High School diploma, GED or equivalent
• Required one or more active certification(s): RHIT, RHIA, COC, CCS-P or CCS
• A minimum of seven (7) years of hospital outpatient coding experience (including Ancillary, Emergency Department, Same Day Surgery, Observation, Wound Care, E/M Professional service, Interventional Cardiology, and Interventional Radiology) is required.

Requirements

• Preferred Skills: Bachelor's or Associate Degree

Benefits

• For this US-based position, the base pay range is $28.24 - $40.21 per hour. Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.
• Competitive benefits package.