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 (DRG) assignments
• Investigate and review medical records to provide clinical and coding expertise in the claims adjudication process
• 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 inpatient DRG coding and medical records review
• Proficiency in performing financial analysis/audits, including statistical calculation and interpretation