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Remote Recovery Audit Jobs in New York (NOW HIRING)

Jzanus Consulting

DRG Validator- Remote

Garden City, NY · Remote

$85K/yr

Write clear, accurate, and concise rationales supporting audit findings. Compose physician queries ... recovery auditing. Minimum of 5+ years of working with ICD-10-CM/PCS, MS-DRG, and APR-DRG with a ...

Oscar Health

Clinical Investigator

New York, NY · On-site +1

$67K - $89K/yr

The Senior Analyst, SIU Clinical Investigator detects and audits aberrant billing patterns within ... This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, Illinois ...

The AES Group

z/OS System Programming

New York, NY · Remote

Remote Let's create our future together at The AES Group! About The AES Group The AES Group is a ... Support Disaster Recovery (DR) planning and execution, including drills and failover validation

NextDeavor Inc.

Security Engineer

New York, NY · On-site +1

Security Engineer Full-time Remote Exclusive confidential search -- details shared with qualified ... Audit and rationalize identity and access across cloud, SaaS, and internal tooling; drive SSO ...

Enghouse

Director of Infrastructure

Paramus, NJ · Remote

Oversee disaster recovery, backup, business continuity, and operational resilience programs ... Ensure infrastructure practices comply with internal controls, audit expectations, data protection ...

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Remote Recovery Audit information

What is a remote recovery audit?

A Remote Recovery Audit is a process where professionals review a company's financial transactions and records from a remote location to identify and recover lost revenue due to overpayments, duplicate payments, or compliance errors. This type of audit is typically performed using secure digital tools and software, allowing auditors to access necessary data without being physically present at the client site. Remote recovery audits are widely used in industries such as healthcare, retail, and finance to ensure financial accuracy and recover funds that might otherwise be missed.

What are the key skills and qualifications needed to thrive as a remote recovery audit professional?

To excel as a Remote Recovery Audit professional, you typically need a background in finance, accounting, or healthcare administration, with expertise in auditing and claims analysis. Familiarity with audit management software, claims processing systems, and data analysis tools is crucial, and certifications like Certified Professional Medical Auditor (CPMA) or Certified Internal Auditor (CIA) can be advantageous. Strong attention to detail, analytical thinking, and effective communication are important soft skills for identifying discrepancies and collaborating with teams remotely. These qualifications ensure accurate recovery of funds, compliance with regulations, and efficient resolution of discrepancies in a remote work environment.

What are some common challenges faced by professionals in a remote recovery audit role, and how can they be addressed?

Professionals in Remote Recovery Audit often encounter challenges such as managing large volumes of transactional data, ensuring accuracy while working independently, and communicating effectively with clients or internal teams across different time zones. To address these challenges, it’s important to develop strong organizational skills, leverage audit software and automation tools, and establish regular check-ins with team members. Additionally, maintaining clear documentation and following established audit protocols can help mitigate errors and streamline the recovery process.

What is the difference between Remote Recovery Audit vs Remote Accounts Payable Specialist?

AspectRemote Recovery AuditRemote Accounts Payable Specialist
CertificationsCPA, Certified Recovery AuditorAP Certification, Microsoft Office skills
Work EnvironmentRemote, audit firms, healthcare, insuranceRemote, finance departments, corporate offices
Industry UsageHealthcare, insurance, governmentRetail, manufacturing, corporate finance
Job FocusIdentifying overpayments, recovering fundsProcessing invoices, managing payments

Remote Recovery Auditors focus on reviewing financial transactions to recover overpaid funds, often requiring audit certifications. Remote Accounts Payable Specialists handle invoice processing and payment management, typically with finance certifications. While both roles are remote and finance-related, their core functions and industry applications differ significantly.

What are the most commonly searched types of Recovery Audit jobs in New York?

The most popular types of Recovery Audit jobs in New York are:

What are popular job titles related to Remote Recovery Audit jobs in New York?

For Remote Recovery Audit jobs in New York, the most frequently searched job titles are:

What job categories do people searching Remote Recovery Audit jobs in New York look for?

The top searched job categories for Remote Recovery Audit jobs in New York are:

What cities in New York are hiring for Remote Recovery Audit jobs?

Cities in New York with the most Remote Recovery Audit job openings:

Remote Recovery Audit jobs near you
Infographic showing various Remote Recovery Audit job openings in New York as of August 2026, with employment types broken down into 3% As Needed, 66% Full Time, 27% Part Time, and 4% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution.

Manager, Benefits Coordination and Claims

EmblemHealth

New York, NY • Remote

Full-time

Medical

Re-posted 28 days ago

EmblemHealth rating

9.2

Company rating: 9.2 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

21st of 309 rated insurance

Job description

REMOTE

Summary of Position

  • Responsible for leading and optimizing the organization's secondary payer and revenue recovery processes across all lines of business, establishing performance metrics and accountability standards aligned with organizational goals.
     
  • Lead, supervise, and develop a team of COB Specialists, establishing performance metrics and accountability standards aligned with organizational goals
     
  • Ensure accurate identification and management of Other Health Insurance (OHI), compliance with CMS and regulatory requirements, and operational excellence within COB functions.
     
  • Monitor and analyze COB metrics, denial trends, and recovery outcomes; implement process improvements to enhance operational effectiveness.
     
  • Drive strategic initiatives to reduce claim overpayment, improve recovery outcomes, and strengthen financial performance while maintaining regulatory integrity.


Principal Accountabilities

  • Oversee end-to-end COB operations, including identification and validation of Other Health Insurance (OHI), Medicare Secondary Payer (MSP) processing, and commercial coordination rules. Ensure accurate application of Medi Investigate and resolve complex COB claim denials, payment disputes, and escalated provider or member inquiries.
     
  • Ensure accurate application of Medicare, Medicaid, Essential Plan, Exchange, and Commercial Group Health Plan COB rules.
     
  • Ensure full compliance with Centers for Medicare & Medicaid Services (CMS) regulations, including Medicare Secondary Payer (MSP) requirements, and Section 111 quarterly filings.
     
  • Maintain adherence to federal and state COB regulations across all product lines, including Medicaid and Exchange plans.
     
  • Investigate and resolve complex COB claim denials, payment disputes, and escalated provider or member inquiries.
     
  • Identify root cause of issues and work with internal teams to improve processes and close process gaps.
     
  • Collaborate and work cross-functionally with other operational areas (Claims, Provider Network Management, Contract Configuration, Provider File Operations, Payment Integrity, etc.) to ensure root causes are remediated for both overpayment and underpayments.
     
  • Lead internal and external compliance audits and regulatory obligations.
     
  • Implement corrective action plans in response to audit findings, regulatory updates, or compliance reviews.
     
  • Support internal and external audits by maintaining accurate documentation, policies, and standard operating procedures.
     
  • Partner with Claims, Enrollment, Finance, Compliance, and IT to ensure data integrity, accurate eligibility verification, and system optimization.
     
  • Responsible for vendor relationships and recovery audit processes, as applicable.
     
  • Develop and deliver ongoing team training to ensure regulatory updates, policy changes, and system enhancements are effectively implemented.
     
  • Perform other duties as assigned or required.

Qualifications

  • 5 - 8+ years' relevant work experience in claims operations within a health insurance carrier environment required
     
  • Bachelor's degree required; additional experience/specialized training may be considered in lieu of degree
     
  • Demonstrated expertise in Medicare, Medicaid, Essential Plan, Exchange, and Commercial Group Health Plan Coordination of Benefits rules required
     
  • 5+ years' experience managing staff / processes required
     
  • In-depth knowledge of HIPAA regulations and CMS guidelines, including Medicare Secondary Payer requirements required
     
  • Strong understanding of COB investigative processes, overpayment recovery methodologies, and denial management required
     
  • Proficiency with claims processing platforms such as Facets and related eligibility and enrollment systems required
     
  • Advanced analytical skills with the ability to interpret claims data, identify trends, and implement corrective strategies required
     
  • Excellent communication and leadership skills with the ability to drive accountability and cross-functional collaboration required
     
  • Strong organizational and auditing skills and attention to detail with a focus on operational efficiency and compliance integrity required
     
  • Ability to effectively organize, prioritize, and manage multiple tasks/projects with simultaneous conflicting deadlines required
     
  • Strong analytic, decisionmaking, and problemsolving abilities required
     
  • Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required
     
  • Demonstrated leadership skills in a matrix environment required
     
  • Ability to discern and identify patterns/trends of issues and provide recommendations for resolution required
Additional Information
  • Requisition ID: 1000003153
  • Hiring Range: $77,760-$149,040

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