Recovery Auditor
A Recovery Auditor identifies overpayments and errors in billing processes to recover funds for an organization, typically within the context of accounting or finance operations.
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Sample Job Descriptions for Recovery Auditor
Below are the some sample job descriptions for the different experience levels, where you can find the summary of the role, required skills, qualifications, and responsibilities.
Junior (0-2 years of experience)
Summary of the Role
A Recovery Auditor is responsible for identifying overpayments to suppliers or vendors, resulting from duplicate payments, pricing discrepancies, unclaimed discounts, or other errors. The role involves analysing financial transactions, reconciling accounts, and working with various departments to recover funds for the company.
Required Skills
- Analytical skills.
- Problem-solving.
- Communication skills.
- Data analysis.
- Financial reporting.
- Time management.
Qualifications
- Bachelor's degree in Accounting, Finance, or related field.
- Knowledge of financial processes, including accounts payable and receivable.
- Strong analytical and problem-solving skills.
- Ability to communicate effectively both in writing and verbally.
- Proficient in Microsoft Office Suite, especially Excel.
- Attention to detail with the ability to identify financial discrepancies.
Responsibilities
- Conduct audits of payments to vendors and suppliers to identify overpayments or irregularities.
- Collaborate with accounts payable and other financial departments to reconcile discrepancies.
- Prepare reports summarizing audit findings and recovery amounts.
- Contact vendors and suppliers to arrange for the return of overpaid amounts.
- Work with legal or compliance teams if recoveries involve contractual disputes.
- Maintain accurate records of audits conducted and recoveries made.
- Assist in developing and implementing policies and procedures to prevent future overpayments.
Intermediate (2-5 years of experience)
Summary of the Role
As a Recovery Auditor, you will be responsible for identifying and reclaiming overpayments made by healthcare insurance companies to providers. You will work closely with clients to review and analyze healthcare claims, ensuring proper payment according to contracts and regulations. Your role is vital in maintaining financial integrity and compliance within the healthcare reimbursement process.
Required Skills
- Analytical and critical thinking skills.
- Attention to detail and accuracy.
- Excellent communication and interpersonal skills.
- Ability to handle confidential and sensitive information.
- Proficiency in data analysis and audit software.
Qualifications
- Bachelor's degree in Finance, Accounting, Healthcare Administration, or related field.
- 2+ years of experience in claims auditing, healthcare billing, or a related field.
- Strong knowledge of healthcare reimbursement methodologies and regulatory compliance.
- Proficiency in medical coding, including ICD-10, CPT, and HCPCS codes.
- Experience with audit software and healthcare claims databases.
Responsibilities
- Conducting detailed audits of healthcare claims to identify overpayments and underpayments.
- Analyzing and interpreting insurance contracts, provider agreements, and billing regulations.
- Collaborating with healthcare providers to gather necessary documentation and explain audit findings.
- Communicating with insurance companies to recover overpaid amounts.
- Utilizing audit software and claim databases to support audit processes.
- Preparing and presenting audit reports to management and clients.
- Staying up-to-date with the latest healthcare billing practices and reimbursement policies.
Senior (5+ years of experience)
Summary of the Role
As a senior Recovery Auditor, you will be responsible for identifying and recouping financial losses due to overpayments, underpayments, and billing errors. Your in-depth understanding of accounting principles, your analytical skills, and your attention to detail will be crucial in detecting discrepancies and recovering funds. You will work closely with accountants, compliance officers, and other financial professionals to ensure the financial integrity of the organization you work for.
Required Skills
- Exceptional analytical and quantitative skills.
- Excellent attention to detail and accuracy.
- Strong communication and negotiation skills.
- Ability to manage multiple audits and projects simultaneously.
- Proficiency in Excel and data analysis tools.
- High ethical standards and integrity in handling financial information.
Qualifications
- Bachelor’s degree in Accounting, Finance, or a related field.
- Certification such as Certified Public Accountant (CPA) or Certified Internal Auditor (CIA) is preferred.
- Minimum of 5 years of experience in recovery auditing, accounting, or financial analysis.
- Strong knowledge of accounting principles, financial reporting standards, and compliance regulations.
- Experience with data analysis and financial software applications.
- Proven track record of successful fund recovery and financial discrepancy resolution.
Responsibilities
- Conduct audits of financial transactions and documentation to identify overpayments, underpayments, and billing errors.
- Collaborate with other financial teams such as accounting, compliance, and legal to address and resolve discrepancies.
- Develop and implement audit strategies and procedures to maximize recovery efforts.
- Perform detailed analytical reviews and financial research to support audit findings.
- Negotiate settlements and manage the recovery of funds.
- Provide recommendations for process improvements to prevent future financial losses.
- Prepare reports and update management on audit status and recovery results.
- Stay updated on industry standards, regulations, and best practices in recovery auditing.
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