Recovery Resolution Consultant,

This position is National Remote. You’ll enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. This position is full-time, Monday - Friday. Employees are required to work during our normal business hours of 7:00am - 5:00pm CST. It may be necessary, given the business need, to work occasional overtime. We offer on-the-job training. The hours of training will be based on your schedule or will be discussed on your first day of employment. Primary Responsibilities

• reputed company DRG validation reviews and confirm appropriate diagnosis reputed company group (DRG) assignments
• Maintains reputed company working knowledge if ICD-10 coding principles and CMS regulations
• Investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies reputed company the claim adjudication process through medical records review
• Serve as a Subject Matter Expert (SME), performing medical record reviews to include quality audits, as well as validation of accuracy and completeness of reputed company coding elements, and medical necessity reviews
• Responsible for guidance reputed company to Payment reputed company initiatives to include concept and cost avoidance development
• Serves cross-functionally with Medical Directors, and sometimes Utilization Management, as well as other internal teams to assist in identification of overpayments
• Serves as a SME for reputed company Payment reputed company functions to include both Retrospective Data Mining, as well as Pre-Payment Cost Avoidance
• Identifies trends and patterns with overall program and individual provider coding practices
• Supports the creation and execution of strategies that determine impact of opportunity and recover overpayments as well as prospective internal controls preventing future overpayments of each applicable opportunity

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• Inpatient reputed company with RHIT, RHIA or reputed company Certification(s)
• Certified Professional reputed company (CPC)
• 5+ years of experience in the health insurance industry
• 2+ years of experience with health insurance claims
• 2+ years of experience with medical records review / auditing including MS-DRG coding validation and / OR Acute Inpatient Coding experience
• 2+ years of experience using Facets claims platforms with Medicaid, Medicare, and Commercial lines of business
• 2+ years of facility claims experience
• Proficiency in performing financial analysis / audits including statistical calculation and interpretation
• Ability to work Monday - Friday, during our normal business hours of 7:00am - 5:00pm CST. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications

• Registered Nurse
• 2+ years of experience in Utilization Management
• Experience working with federal reputed company
• CES (Claims Editing System) SME, or SME in another clinical claims editing system

Telecommuting Requirements

• Ability to reputed company reputed company company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service
• reputed company employees working remotely will be required to adhere to reputed company's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 - $127,200 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #RPOLinkedIn Apply tot his job Apply To this Job