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GOVERNMENT AUDIT RECOVERY SPECIALIST

4 weeks ago

Costa Mesa, United States Hoag Full time

GOVERNMENT AUDIT RECOVERY SPECIALIST - CORPORATE COMPLIANCEPay CompetitiveEmployment type: Full-TimeJob DescriptionReq#: 116908Salary Range: $26.0600 - $39.2700 /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education.Primary Duties and ResponsibilitiesThe 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 ExperienceRequired: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 settingExperience working on complex projects1-3 years of experience in healthcare acute setting regulatory audits and appealsExperience with and understanding of CMS billing, payment and reimbursement methodologiesKnowledge of privacy regulations, security regulations, release of information, CMS rules and regulationsProficiency in Microsoft Office applications (Word, PowerPoint, Excel, Outlook).Preferred:5 years of experience or more in an acute setting3 years of experience in healthcare acute setting regulatory audits and appealsExperience 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 audits5 years of experience in Medicare billing, follow up, appealsKnowledge of utilization management process, coding, medical necessity criteriaAbout the CompanyThe Hoag Health Network consists of hospitals, urgent care & health care centers in Orange County. They are well known for superior patient care & convenient locations #J-18808-Ljbffr