Government Audit Recovery Specialist
2975 Red Hill Ave Costa Mesa, CA 92626 US
**salary will be commensurate with experience**
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.
• 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).
• 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
• High school diploma or equivalent experience
Although this hasn't been an issue at The Planet Group, the staffing industry has seen an increase in people falsely representing themselves as recruiters to gather personal information from job seekers. For your safety, do not provide sensitive data to anyone you have not spoken with thoroughly and never provide banking information during the application process. Candidate safety is a top priority at The Planet Group.