Senior 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 our Senior Rules Associate, Denials, you will help the company by performing trending and analysis on 837/835 data, client extracts and other data sources. Every day, you will create mappings based on payer, CARC/RARC codes, and CPT codes to drive workflow decisions and assist with automating processes and driving efficiency improvements. You will also collaborate with various internal teams to develop workflows and automation needs and build/validate mappings. 

To thrive in this role, you must have intermediate+ level experience with SQL programming and advanced MS Excel experience to develop processes and create clear and accurate reports for internal team members. This position needs someone that thrives in combining technical SQL skills and critical thinking/project-based analysis skills. 

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

• Identify and implement opportunities to optimize internal processes through SQL automation. 

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

• Recommend and assist in implementation of techniques and processes to improve productivity, increase efficiencies, cut costs, and take advantage of potential revenue expanding opportunities. 

• Design and maintain ETL pipelines as well as assist database administrators with SQL Server maintenance and updates. 

Required Skills: 

• Strong conceptual, quantitative, and qualitative analytical skills. 

• 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).