Recovery Resolution Consultant

Job Summary

As a full-time Recovery Resolution Consultant specializing in Payment Integrity, the successful candidate will work remotely to manage operational functions, verify claims payment accuracy, and provide expertise in state and federal compliance policies.

Key responsibilities:

• Support operational processes related to Payment Integrity and ensure adherence to compliance regulations
• Conduct complex data analysis and coordinate with vendors to identify and manage claims overpayments
• Collaborate with various internal and external stakeholders to achieve operational targets and document outcomes of claims investigations

Required qualifications:

• High School Diploma / GED or equivalent work experience
• 3+ years of healthcare operations experience
• 3+ years of experience in health plan and/or managed care business operations
• 3+ years of payment integrity experience, including prepayment and/or post-payment processes
• Proven ability to coordinate and navigate complex matrixed organizations