Recovery Support Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct retrospective analytical evaluations of inpatient and professional claims to assess coding precision, billing integrity, and reimbursement results.

• Examine intricate coding situations using ICD-10-CM/PCS, CPT, HCPCS, DRG, APC, and specific payer guidelines.

• Confirm that clinical documentation substantiates assigned codes, modifiers, and service levels.

• Detect trends in coding mistakes, under-coding, over-coding, or potential compliance concerns.

• Execute internal audits of medical coding, clinical documentation, and claim submissions to ensure adherence to CMS, OIG, commercial payer, and internal policies.

• Compile audit findings, summaries, and suggestions for educational initiatives or corrective measures.

• Assist in the creation and enhancement of audit tools, workflows, and tracking systems.

• Collaborate with coding teams, clinical personnel, and billing departments to clarify documentation and coding challenges.

• Analyze claim activity datasets to pinpoint trends, anomalies, and areas needing improvement.

• Produce clear and concise reports that summarize findings, conduct root-cause analysis, and recommend interventions.

• Aid in the development of dashboards or monitoring tools to oversee coding accuracy and audit results.

• Remain updated on changes in coding guidelines, regulatory adjustments, and payer billing policies.

• Ensure claims comply with federal/state regulations, payer contracts, and organizational standards.

• Support quality enhancement initiatives aimed at improving documentation, coding, and reimbursement accuracy.

• Collaborate with coding, revenue cycle, clinical, and recovery teams to address coding or billing discrepancies.

• Educate staff on audit findings, coding best practices, and documentation requirements.

• Engage in meetings and workgroups focused on coding quality, documentation integrity, and compliance.

⛳️ Requirements

• Demonstrated experience in retrospective analytical review of inpatient and professional claims.

• Extensive knowledge of ICD-10-CM/PCS, CPT, HCPCS, DRG methodology, APCs, and payer reimbursement regulations.

• Strong analytical, critical thinking, and problem-solving capabilities.

• Experience with EMRs, coding software, and claims/billing platforms.

• Exceptional communication and technical writing abilities.

• Capacity to manage multiple priorities with precision and attention to detail.

• Proficiency in Microsoft applications, including Word, Excel, and Outlook.

• Bachelor's Degree is preferred.

• A minimum of five years of experience in claims analysis or a related field.

• Certified Professional Coder (CPC) from AAPC and/or Certified Coding Specialist (CCS) certification from AHIMA for medical coding or similar credentials are strongly preferred.

🏝️ Benefits

• Travel is required for on-site client visits approximately 10% of the time.

• Intermittent physical effort may include lifting up to 25 lbs., walking, stopping, kneeling, crouching, or crawling as needed.

• Frequent sitting, keyboard usage, reaching with hands and arms, and talking and hearing approximately 70% of the time; standing occurs 30% or less of the time.

• Normal vision abilities are required, including close vision and the capacity to adjust focus.