Certified Recovery Consultant

Job Summary

A company is looking for a Recovery Resolution Consultant.

Key Responsibilities

• Perform DRG validation reviews and confirm appropriate diagnosis related group assignments
• Investigate and provide clinical and coding expertise in the claim adjudication process through medical records review
• Identify trends in coding practices and support strategies to recover overpayments and prevent future occurrences

Required Qualifications

• High School Diploma / GED or equivalent work experience
• Certified coder with AHIMA or AAPC (e.g., RHIA, RHIT, CPC, CIC)
• 5+ years of experience in the health insurance industry
• 2+ years of experience with health insurance claims and medical records review/auditing
• Proficiency in performing financial analysis/audits, including statistical calculation and interpretation