Complex Denials Consultant (Complex Claims)

Join R1 RCM as a Complex Denials Consultant in Boise, Ada County, where you'll specialize in resolving intricate claim denials that directly impact patient financial experiences and provider revenue performance. This is a full-time position for a dedicated professional ready to make a meaningful difference in healthcare revenue cycle management.

About the Role

As a Complex Denials Consultant in our Complex Claims division, you'll investigate, analyze, and work toward resolution of high-complexity claim denials. Your expertise will help our healthcare provider clients recover revenue and streamline their billing operations. You'll partner closely with billing teams, medical groups, hospitals, and health systems across the nation, applying both analytical rigor and deep knowledge of denial root causes to drive outcomes.

What You'll Do

• Examine complex claim denials to identify underlying issues, patterns, and systemic gaps
• Research denial reasons spanning clinical documentation, coding accuracy, insurance policy compliance, and billing procedures
• Prepare and submit appeals with thorough documentation and clinical justification
• Collaborate with healthcare provider teams to clarify clinical information and resolve denial triggers
• Track denial resolution progress and maintain detailed records of all case actions
• Use data analytics and reporting tools to identify opportunities for reducing denial volume
• Communicate findings and recommendations clearly to internal teams and provider partners
• Stay current on payer policies, regulatory requirements, and industry best practices

What We're Looking For

• Proven experience analyzing and resolving healthcare claim denials, with emphasis on complex cases
• Strong understanding of medical coding, healthcare billing, and insurance reimbursement processes
• Excellent written and verbal communication skills for working across teams and healthcare organizations
• Ability to manage multiple high-complexity cases while maintaining attention to detail
• Proficiency with healthcare billing systems, analytics platforms, and data management tools
• Self-directed work ethic and problem-solving mindset in an evolving healthcare landscape
• Relevant certifications or coursework in healthcare revenue cycle, medical coding, or billing preferred

About R1 RCM

R1 RCM is the industry leader in delivering technology-powered solutions that enhance patient experiences and strengthen the financial health of hospitals, health systems, and medical groups nationwide. Our global team of revenue cycle professionals combines deep industry expertise with cutting-edge technology—including advanced analytics, artificial intelligence, and intelligent automation—to deliver measurable results. When you join R1 RCM, you become part of a mission-driven organization committed to transforming healthcare.

How to Apply

To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.