Recovery Support Analyst

amps

Claims Analyst focusing on retrospective reviews of healthcare claims for coding accuracy and compliance. Collaborating with teams to ensure adherence to regulatory standards and quality improvement initiatives.

Posted 6/12/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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

Comp & perks

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.

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

ICD-10-CMICD-10-PCSCPTHCPCSDRGAPCclaims analysiscoding accuracybilling integrityreimbursement outcomes

Soft Skills

analytical skillscritical thinkingproblem-solvingcommunication skillstechnical writingattention to detailtime managementcollaborationeducationreporting

Certifications

Certified Professional Coder (CPC)Certified Coding Specialist (CCS)