Texas Licensed 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 provide clinical and coding expertise in medical records review for claim adjudication
• Serve as a Subject Matter Expert (SME) for Payment Integrity initiatives, identifying overpayments and supporting strategies to recover them

Required Qualifications

• High School Diploma / GED or equivalent work experience
• Inpatient Coder with RHIT, RHIA, or CCS Certification(s)
• 5+ years of experience in the health insurance industry
• 2+ years of experience with health insurance claims and medical records review/auditing
• Proficiency in financial analysis/audits including statistical calculation and interpretation