GOVERNMENT AUDIT RECOVERY SPECIALIST - CORPORATE COMPLIANCE

Hoag; Costa Mesa (CA); On-site; Full time

Job summary

An established industry player in healthcare is seeking a Government Audit Recovery Specialist to join their dynamic team. This role is pivotal in ensuring compliance with government regulations, particularly within the Medicare framework. You will engage in various tasks, including data entry, audit preparation, and correspondence with government contractors. The ideal candidate will possess extensive Medicare billing experience and a strong understanding of CMS regulations, making this a vital position in maintaining the integrity of healthcare billing practices. Join a team dedicated to superior patient care and contribute to meaningful compliance efforts.

Qualifications

• 3+ years of Medicare billing experience in an acute care setting.
• Proficiency in Microsoft Office applications is essential.

Responsibilities

• Perform duties related to government regulatory audits for billing compliance.
• Respond to correspondence from Government Agencies regarding audits.

Skills

Medicare billing experience

Data entry

Understanding of CMS regulations

Project management

Proficiency in Microsoft Office

Knowledge of privacy regulations

Education

High school diploma or equivalent

Tools

Microsoft Word

Microsoft PowerPoint

Microsoft Excel

Microsoft Outlook

Job description

GOVERNMENT AUDIT RECOVERY SPECIALIST - CORPORATE COMPLIANCE

Pay Competitive

Employment type: Full-Time

Job Description

Req#: 116908

Salary Range: $26.0600 - $39.2700 /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education.

Primary Duties and Responsibilities

The Government Recovery Specialist performs duties associated with Centers for Medicare and Medicaid Services (CMS) Recovery Audit Contractor (RAC) program and other government regulatory and enforcement agency audits for documentation and billing compliance. This includes data entry, processing of mail, preparation of audit information, and correspondence with government contractors as needed. This role has a fundamental understanding of the RAC program and other audits for documentation and billing compliance. As an essential role and focal point of all government audit activity, the Government Recovery Specialist is responsible for responding to correspondence from Government Agencies related to Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), Quality Improvement Organizations (QIO), and other Medicaid, Medi-Cal regulatory auditing body for pre and post payment audits.

Education and Experience

Required:

• High school diploma or equivalent experience (employees hired prior to 2011 without a HS diploma are grandfathered into their position)
• 3 years of Medicare billing experience in billing, follow up, in an acute care setting
• Experience working on complex projects
• 1-3 years of experience in healthcare acute setting regulatory audits and appeals
• Experience with and understanding of CMS billing, payment and reimbursement methodologies
• Knowledge of privacy regulations, security regulations, release of information, CMS rules and regulations
• Proficiency in Microsoft Office applications (Word, PowerPoint, Excel, Outlook).

Preferred:

• 5 years of experience or more in an acute setting
• 3 years of experience in healthcare acute setting regulatory audits and appeals
• Experience working on government, Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), and other Medicaid, Medi-Cal and other regulatory audits
• 5 years of experience in Medicare billing, follow up, appeals
• Knowledge of utilization management process, coding, medical necessity criteria

About the Company

The Hoag Health Network consists of hospitals, urgent care & health care centers in Orange County. They are well known for superior patient care & convenient locations!