A Compliance Auditor examines records and procedures to determine adherence to regulatory guidelines of an organization. Inspects accounting, IT or security, prepares reports on the compliance with required regulations and risk management procedures.
Temporary Hoag Health System - 4.0 Costa Mesa, CA Job Details Temporary 15 hours ago Qualifications Appeals Microsoft Excel Microsoft Outlook Medicare CMS Regulatory compliance Word embeddings Medical claim appeals CMS regulatory compliance Medicare regulations Healthcare privacy protection Health information regulatory compliance Medical insurance appeals management Centers for Medicare & Medicaid Services (CMS) billing regulations Medicaid regulations Medicaid Acute care experience Healthcare claims compliance audits Medical billing insurance follow-up Full Job Description 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 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 License Required N/A License Preferred N/A Certifications Required N/A Certifications Preferred CPC CCS
