Coder II

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

Education:
Required Education: -High school diploma or equivalent experience.
High school diploma or equivalent experience

This is the pay range that 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: Read, Write, Speak

Skills:
Required
Billing, Follow-Up, Regulatory Audits, Appeals, Medicare Billing

Additional
Utilization Management Process, Word, Comprehensive Error Rate Testing (Cert), Office Of Inspector General (Oig), Medicaid Audits, Medi-Cal Audits Outlook, Acute Care Experience, Government Audits, Coding, Medical Necessity Criteria, CMS Billing, payment methodologies, reimbursement methodologies, privacy regulations. Security regulations, release of information, Cms rules and regulations, microsoft office, powerpoint, Excel, Recovery Audit Contractor (Rac), Medicare Administrative Contractor (Mac), Targeted Provider Education (Tpe)

Schedule Notes:
Is this position Remote No
Work Location Address: 2995 Red Hill Ave Costa Mesa CA LOA Coverage