Hoag Health System · 12 hours ago
Government Audit Recovery Specialist: Corporate Compliance
Costa Mesa, CA
Full-time
Onsite
Mid Level
3+ years expHoag Health System is a nonprofit regional health care delivery network in Orange County, California, and they are seeking a Government Audit Recovery Specialist. This role involves performing duties associated with CMS Recovery Audit Contractor program and other government regulatory audits for documentation and billing compliance, including data entry, audit preparation, and correspondence with government contractors.
Hospital & Health Care
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
Qualification
Required
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
CPC
CCS
Company
Hoag Health System
Hoag is a nonprofit, regional health care delivery system in Orange County, California.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Robert Braithwaite
President and Chief Executive Officer
Eric Cheung
Chief Legal Officer, General Counsel, Senior Vice President
Recent News
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2025-07-14
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