A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.
We are seeking a Government Audit Recovery Specialist for a healthcare organization to support government regulatory audits and Medicare compliance. The role involves managing audit requests, preparing documentation, processing correspondence, and responding to agencies such as RAC, MAC, TPE, CERT, OIG, QIO, and other Medicare/Medicaid regulatory bodies. The ideal candidate will have experience with Medicare billing, appeals, CMS reimbursement guidelines, and acute care regulatory audits.
Requirements:
High school diploma or equivalent 3+ years of Medicare billing and follow-up experience in an acute care setting 1-3 years of healthcare regulatory audit and appeals experience Knowledge of CMS billing, reimbursement methodologies, privacy regulations, and release of information Proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint)
Preferred:
5+ years of acute care and Medicare billing experience Experience with RAC, MAC, TPE, CERT, OIG, QIO, Medicaid, Medi-Cal, and other government audits Knowledge of utilization management, coding, and medical necessity criteria
Pay:
$30.00 - $34.00 per hour Application Question(s): Do you have at least 3 years of Medicare billing and follow-up experience in an acute care hospital setting? How many years of healthcare regulatory audit and appeals experience do you have?
