GOVERNMENT AUDIT RECOVERY SPLST - CORPORATE COMPLIANCE

Salary Range: $26.5700 - $40.8500 /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education.

 

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

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

 

Certifications Preferred

CPC

CCS

Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.