Government Audit Recovery Specialist

Company Description: IMCS Group is one of the fastest growing MWBE (Minority Woman Owned Enterprise) staffing firms in the U.S. We focus on bringing a Diversity Recruitment approach to Fortune 500 companies within North America and EMEA region contingent labor programs. IMCS Group excels in providing top talent in IT, Healthcare, Engineering, Finance, Light Industrial, Contact Center, and Clerical. We have offices in the US, Canada, Mexico, and India in which we can provide support to our clients.

Description

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), 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.
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.

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), 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.
• 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
Required
BILLING
FOLLOW-UP
REGULATORY AUDITS
APPEALS
MEDICARE BILLING

Additional
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)
TARGETED PROVIDER EDUCATION (TPE)
COMPREHENSIVE ERROR RATE TESTING (CERT)
OFFICE OF INSPECTOR GENERAL (OIG)
MEDI-CAL AUDITS
UTILIZATION MANAGEMENT PROCESS
CODING

Education

Required Education: -High school diploma or equivalent experience. Preferred Education: -N/A Required Certifications & Licensure: -N/A Preferred Certifications & Licensure: -N/A
• High school diploma or equivalent experience
This is the pay range that RightSourcing (a part of Magnit) reasonably expects to pay someone for this position, however, as a supplier your expected pay range may vary and/or include certain benefits like: Stipends (for clinical traveler workers only), Medical, Dental, Vision, 401K [include any compulsory benefits such as commissions, incentive bonuses, etc. if applicable]. Pay range (USD)25 hrly - (USD)37 hrly

Languages

English( Speak, Read, Write )

EEOC Disclaimer: IMCS Group is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law. IMCS Group is committed to maintaining an inclusive workforce, where employees are hired, retained, compensated, and promoted based on their contributions to our Company.