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State Licensed Recovery Consultant
A company is looking for a Recovery Resolution Consultant - National Remote. Key Responsibilities Investigate and review medical records, providing expertise in medical and reimbursement policies during claim adjudication Serve as a Subject Matter Expert (SME) for medical record reviews, quality audits, and Payment Integrity initiatives Identify trends in coding practices and support strategies for recovering overpayments and preventing future occurrences Required Qualifications Registered Nurse Certified Professional Coder (CPC) or willingness to obtain within 6 months of hire 5+ years of experience in the health insurance industry 2+ years of experience with health insurance claims and medical records review/auditing Proficiency in claims platforms and Microsoft Office applications
A company is looking for a Recovery Resolution Consultant - National Remote.
Key Responsibilities
Investigate and review medical records, providing expertise in medical and reimbursement policies during claim adjudication
Serve as a Subject Matter Expert (SME) for medical record reviews, quality audits, and Payment Integrity initiatives
Identify trends in coding practices and support strategies for recovering overpayments and preventing future occurrences
Required Qualifications
Registered Nurse
Certified Professional Coder (CPC) or willingness to obtain within 6 months of hire
5+ years of experience in the health insurance industry
2+ years of experience with health insurance claims and medical records review/auditing
Proficiency in claims platforms and Microsoft Office applications