State Licensed Recovery Analyst

Job Summary

To support accurate claims processing, the full-time, remote State Licensed Recovery Analyst will analyze medical records and claims submissions, exercise judgment on complex payment decisions, and ensure compliance with coding and regulatory guidelines.

Key responsibilities:

• Perform quality audits of clinical review cases related to medical coding and billing
• Determine the accuracy of claims and provide payment recommendations for post-payment reviews
• Manage daily case review assignments while adhering to quality and productivity standards

Required qualifications:

• High School Diploma or GED
• Certification as a medical coder from AHIMA or AAPC (CPC, CCS, CCS-P, RHIT, CPMA, RHIA, CDIP)
• 2+ years of experience in medical record auditing and coding/billing
• 1+ year of experience in a metric-driven team environment
• Intermediate level of experience with health insurance terminology and regulatory guidelines