Clinical Appeals Supervisor

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 Supervisor, you will help support clinicians who conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical necessity criteria, physician documentation, and medical policies of the payor. Every day you will supervise the day-to-day clinical operations and functions within the department, ensuring productivity and quality metrics are met and regularly identify and communicate denial trends and patterns to leadership. To thrive in this role, you must have experience supervising in a clinical inpatient environment and the ability to use sound judgment in reviewing clinical documentation supporting patient care as well as conceptual knowledge of the denials landscape. Proficiency in basic computer skills is essential for excelling in this remote position.

Track and monitor the workflow of the clinical team daily to ensure internal and external compliance deadlines are met. Track clinicians’ productivity and quality by performing regular audits of appeals. Evaluate and report on overturned appeals to continuously refine clinical practices and ensure optimal outcomes. Assess the viability of cases for external review or escalation, as well as make final determinations on clinical appeals that require no further action. Act as a liaison for non-clinical staff and attorneys to collaborate on appeals processing. Leverage employee engagement data to identify targeted areas for additional support and engagement.