[‘BILLING’, ‘FOLLOW-UP’, ‘REGULATORY AUDITS’, ‘APPEALS’, ‘MEDICARE BILLING’]

[‘MEDICAID AUDITS’, ‘MEDICAL NECESSITY CRITERIA’, ‘CMS BILLING’, ‘PAYMENT METHODOLOGIES’, ‘REIMBURSEMENT METHODOLOGIES’, ‘PRIVACY REGULATIONS’, ‘SECURITY REGULATIONS’, ‘RELEASE OF INFORMATION’, ‘CMS RULES AND REGULATIONS’, ‘MICROSOFT OFFICE’, ‘WORD’, ‘POWERPOINT’, ‘EXCEL’, ‘OUTLOOK’, ‘ACUTE CARE EXPERIENCE’, ‘GOVERNMENT AUDITS’, ‘RECOVERY AUDIT CONTRACTOR (RAC)’, ‘MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)’, ‘ClientED PROVIDER EDUCATION (TPE)’, ‘COMPREHENSIVE ERROR RATE TESTING (CERT)’, ‘OFFICE OF INSPECTOR GENERAL (OIG)’, ‘MEDI-CAL AUDITS’, ‘UTILIZATION MANAGEMENT PROCESS’, ‘CODING’]Duties:
Position Summary:
-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), Cliented 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.

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), Cliented 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.

Skills:
Required Skills & Experience:
-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 Skills & Experience:
-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), Cliented 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.

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), Cliented 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

Schedule Notes:
Is this position Remote? No
Work Location Address: 2995 Red Hill Ave Costa Mesa CA
LOA Coverage