Recovery / Resolutions Analyst Job Description
Recovery / resolutions analyst
provides feedback and guidance on methodologies, techniques, models and tools to ensure alignment with internal and regulatory guidelines.
Recovery / Resolutions Analyst Duties & Responsibilities
To write an effective recovery / resolutions analyst job description, begin by listing detailed duties, responsibilities and expectations. We have included recovery / resolutions analyst job description templates that you can modify and use.
Sample responsibilities for this position include:
Error
Review medical records to identify appropriate coding based on CMS requirements
Investigate all types of professional claims to identify savings for our customers
Monitor coding changes to ensure that most current information is utilized
Adhere to turn around time and standards
Perform investigation on tips / allegations to identify potential Fraud, Waste, Abuse, or Error
Investigate and identify overpayments on all claims types, assist in recovery and resolution for health plans, commercial customers, and government entities as needed
Investigate, audit, and resolve all types of Medicaid claims recovery and resolution for government payers
Investigates, maps, and analyzes customer disruption experiences and commercial initiatives
Implements process and/or technology initiatives that support positive customer and employee outcomes
Recovery / Resolutions Analyst Qualifications
Qualifications for a job description may include education, certification, and experience.
Education for Recovery / Resolutions Analyst
Typically a job would require a certain level of education.
Employers hiring for the recovery / resolutions analyst job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and High School Degree in Auditing, Healthcare, Nursing, Associates, Statistics, Business, Music, Philosophy, Math, Economics
Skills for Recovery / Resolutions Analyst
Desired skills for recovery / resolutions analyst include:
Medicaid / Medicare Reimbursement methodologies
Claims processing systems and guidelines / processes
Encoder systems
Health insurance business
Industry terminology and regulatory guidelines
Internal and External Policies
Laws and Regulations
Regulatory guidelines
Desired experience for recovery / resolutions analyst includes:
An undergraduate degree (or higher) or HSD/GED with 4+ years healthcare experience
Bachelor’s degree (or higher) or High School Diploma with 1+ years of relevant experience (healthcare billing, claims, auditing, reimbursement, or data analysis
Must possess a current Coding Certification CPC, CPMA, CEMC, CCS-P, RHIT, or a current license as an RN or LPN WITH coding experience
Must be able to create, edit, copy, send and save documents, correspondence and spreadsheets in Microsoft Word, Excel, and Outlook
Experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond
Have a secluded office area in which to perform job duties during the work day
Recovery / Resolutions Analyst Examples
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Recovery / Resolutions Analyst Job Description
Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of recovery / resolutions analyst. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for recovery / resolutions analyst
- Determines inputs for policies and guidance utilized during disruptions and irregular operations
- Handle more complex tasks
- Candidate should be able to support and work in a classroom environment
- Identify and streamline processes to enhance the training program
- Work with Quality and Documentation
- This could include Medical Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
- Performs clinical coverage review of post - service which requires interpretation of state and federal mandates, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information on claims with over billing patterns
- Flag Management
- Must enjoy working in a fast paced, production environment
- Provide expertise in Outreach Operations to support contractual agreements with our clients by reviewing, analyzing, researching, investigating, and finding resolutions in discrepancies with CMS and Health Plan data
Qualifications for recovery / resolutions analyst
- Ability to create, manage, and organize email and calendar within MS Outlook
- 1+ years’ experience using claims platforms such as COSMOS, CSP, UNET, Pulse, NICE, Facets, Diamond
- Comfort in working with uncertainty and information gaps preferred
- 1-3 years of related experience in an analytical function required
- Experience with United systems (SHARES, AERO, Enterprise Data Warehouse) preferred
- Undergraduate Degree (or higher) or High School Diploma/GED with 4+ years of equivalent experience in customer service, auditing, or claims
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Recovery / Resolutions Analyst Job Description
Job Description Example
Our company is looking to fill the role of recovery / resolutions analyst. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for recovery / resolutions analyst
- Analyze and identify trends and escalate issues appropriately
- Demonstrated ability to learn multiple programs and understand the business process within each program
- Monitor and audit work for adherence to policies and procedures
- Help ensure monthly deadlines and project due dates are met
- Remain up-to-date on CMS rules as they pertain to Outreach Operations and ensure member detail is corrected according to Medicare guidelines
- Work independently, maintain high quality, understand productivity metrics and quality standards and help guide the team to meet and/or exceed these
- Be a role model
- Demonstrate on the spot comprehensive decision making
- Respond to monitoring, coaching, and various forms of feedback and quality analysis designed to ensure the team stays on schedule and meets or exceeds performance metrics and contractual obligations
- Mentor and train team members as appropriate
Qualifications for recovery / resolutions analyst
- Ability to create and modify documents within MS Word
- College Degree with 4+ years of insurance, lab, or fraud investigation experience OR High School diploma / GED with 5+ years of insurance, lab, or fraud investigation experience
- Ability to work independently with minimal direction, work well within a team environment
- 1+ years of experience as a Subject Matter Expert, Team Lead, or Trainer
- Ability to create and modify spreadsheets, documents, and presentations within Microsoft Excel, Microsoft Word, and Microsoft PowerPoint
- 1+ years of experience with claims auditing and researching claims information, or 1+ year of experience working within the COB department
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Recovery / Resolutions Analyst Job Description
Job Description Example
Our company is looking for a recovery / resolutions analyst. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for recovery / resolutions analyst
- Assist supervisors with various reporting tasks
- Avoid tardiness and excessive unplanned absences
- The analyst will correspond with plaintiff’s attorney, defense counsel, third party insurers, and all other parties of interest
- Meet and maintain minimum quality and productivity
- Auditors are expected to understand all payment methodologies / claim benefits and be able to calculate overpayments that will be communicated to a provider
- Identifies overt billing trends, waste and error identification, and recommends providers to be flagged or filtered for review and works with analytics on recommendations to increase line of business savings by client
- Identifies updated clinical analytics opportunities and participates in projects necessary by client / other departments (5%)
- Maintains and manages daily case review assignments, with a high emphasis on quality, with at least 98% accuracy and within client / CMS guidelines and provides clinical explanation both to the provider (15%)
- Participates in provider / client / network meetings, which may include provider education through written communication and participates in additional projects as needed
- Participates in training of new staff and serves as a clinical resource to other areas within the clinical investigative team and provides guidance and feedback to peers when applicable
Qualifications for recovery / resolutions analyst
- Bachelor’s Degree (or higher) OR 1+ years of relevant experience (healthcare billing, claims, auditing, reimbursement, or data analysis)
- RN, LPN with 2+ years of current experience with an unrestricted license, OR 2+ years of experience as a Certified Coder
- Bachelor’s Degree (or higher) or High School Diploma / GED with 1+ years of relevant experience (healthcare billing, claims, auditing, reimbursement, or data analysis)
- Bachelor’s Degree (or higher) or a High School Diploma / GED with 1+ years of relevant experience (healthcare billing, claims, auditing, reimbursement, or data analysis)
- Bachelor’s Degree (or higher) or High School Diploma/ GED with 3+ years experience in a Recovery/Resolutions Analyst or Similar role
- Knowledge of diagnosis codes and CPT coding guidelines, medical terminology
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Recovery / Resolutions Analyst Job Description
Job Description Example
Our company is hiring for a recovery / resolutions analyst. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for recovery / resolutions analyst
- Review all relevant claims data from the specified System
- Work with case owners to ensure monthly audit recoveries are processed and recorded to standards of the department
- Reconcile the submissions & recoveries data
- Coordinate recovery and reversal of claims with claims ops, finance and internal reporting teams Actively participate in all aspects of audit recovery functions as needed
- Assist management with financial tracking and reporting
- Maintain standards for productivity and accuracy
- Demonstrate proficiency on assigned audits
- Communicate to their manager any issues impeding progress of goals and suggesting solutions to meet and exceed expectations
- Initiate phone calls to members, providers, and other insurance companies to gather information
- Investigate and/or resolve all types of claims for health plans, commercial customers, and government entities
Qualifications for recovery / resolutions analyst
- 1+ years of work experience using MS Excel – sorting, filtering, data input, editing and creating spreadsheets
- Medicare/Medicaid program knowledge preferred
- Undergraduate’s Degree (or higher) in Nursing or similar degree type
- Bachelor Degree (or higher) or High School Diploma / GED and 4+ years of customer service experience
- 3+ years proficiency with computer and Windows PC applications, Microsoft Office products such as Microsoft Word, Microsoft Excel and Microsoft Outlook (ability to create, edit, save, and send documents, spreadsheets and emails)
- 1+ years ability to understand multiple programs and an understanding of the business process within each program
5
Recovery / Resolutions Analyst Job Description
Job Description Example
Our company is looking to fill the role of recovery / resolutions analyst. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for recovery / resolutions analyst
- Collaborate with clinical coding consultants for purposes of educating and communicating to provider
- Review medical records to gather relevant facts to drive investigations and communications
- Conduct data mining and analysis for potential flags
- Communicate clear rationale for investigation processes and outcomes to Client, Regulator and stakeholders (referrals and OP)
- Utilize appropriate systems to monitor and document status of investigations
- Monitor investigation status throughout the process
- Collaborate with a variety of external sources to identify current and emerging patterns and schemes related for FWA
- Data enter key detail from the medical records and claim platform into an online communication
- Meet required productivity and quality metrics
- Adherence to state and federal compliance policies and contract compliance
Qualifications for recovery / resolutions analyst
- 2+ years of experience working in a team leadership or special project role
- Microsoft SharePoint experience with the ability to navigate the system
- 1+ years of experience working with MSP, ESRD, Medicaid, or Hospice
- Persuasiveness and ability to control a call are an asset
- Ability to learn quickly and motivated to meet daily production standards with excellent accuracy
- Remain energetic and have a positive approach to handling pressure and change