Your Holistic Approach to Healthcare Cost Savings Solutions
Recovery Support Analyst
Location
United States
Posted
2 days ago
Salary
0
Seniority
Senior
Job Description
Recovery Support Analyst
amps
• Perform retrospective analytical reviews of inpatient and professional claims to evaluate coding accuracy, billing integrity, and reimbursement outcomes. • Analyze complex coding scenarios using ICD-10-CM/PCS, CPT, HCPCS, DRG, APC, and payer-specific guidelines. • Validate clinical documentation supports assigned codes, modifiers, and levels of service. • Identify patterns of coding errors, under-coding, over-coding, or potential compliance risks. • Conduct internal audits of medical coding, clinical documentation, and claim submissions to ensure compliance with CMS, OIG, commercial payer, and internal policies. • Prepare audit findings, summaries, and recommendations for education or corrective action. • Assist in developing and refining audit tools, workflows, and tracking processes. • Collaborate with coding teams, clinical staff, and billing departments to clarify documentation and coding issues. • Analyze datasets of claim activity to identify trends, anomalies, and areas for improvement. • Prepare clear and concise reports for summarizing findings, root-cause analysis, and recommended interventions. • Support the development of dashboards or monitoring tools to track coding accuracy and audit outcomes. • Stay current with changes in coding guidelines, regulatory updates, and payer billing policies. • Ensure claims adhere to federal/state regulations, payer contracts, and organizational standards. • Support quality improvement initiatives focused on documentation, coding, and reimbursement accuracy. • Partner with coding, revenue cycle, clinical, and recovery teams to resolve coding or billing discrepancies. • Provide education to staff on audit findings, coding best practices, and documentation requirements. • Participate in meetings and workgroups related to coding quality, documentation integrity, and compliance.
Job Requirements
- Proven experience in retrospective analytical review of inpatient and professional claims.
- Deep knowledge of ICD-10-CM/PCS, CPT, HCPCS, DRG methodology, APCs, and payer reimbursement rules.
- Strong analytical, critical thinking, and problem-solving skills.
- Experience working with EMRs, coding software, and claims/billing platforms.
- Excellent communication and technical writing skills.
- Ability to manage multiple priorities with accuracy and attention to detail.
- Competency in Microsoft applications, including Word, Excel, and Outlook.
- Bachelor's Degree Preferred.
- Five or more years of experience in claims analysis or related field.
- Certified Professional Coder (CPC) from AAPC and/or Certified Coding Specialist (CCS) certification from AHIMA for medical coding or similar credentials strongly preferred.
Benefits
- Travel is required for on-site client visits approximately 10% of the time.
- Intermittent physical effort may include lifting to 25 lbs., walking, stopping, kneeling, crouching, or crawling may be required.
- Frequent sitting, use of a keyboard, reaching with hands and arms, talking and hearing approximately 70% of the time; 30% or less time is spent standing.
- Normal vision abilities required, including close vision and the ability to adjust focus.
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