Optum · 14 hours ago
Medicare Recovery Audit Specialist
Concord, CA
Full-time
Onsite
New Grad, Entry Level
$20.38/hr - $36.44/hrOptum is improving the flow of health data and information to create a more connected system. The Medicare Recovery Audit Specialist is responsible for identifying and addressing improper Medicare payments through retrospective claims review, ensuring compliance with Medicare regulations and supporting internal audit responses.
EducationHealth CareMedicalPharmaceutical
Responsibilities
Conduct audits and reviews of Medicare claims to identify overpayments, underpayments, and non-compliance with CMS regulations
Analyze medical records, billing documentation, and coding to ensure accuracy and appropriate reimbursement
Apply CMS guidelines, Medicare National and Local Coverage Determinations (NCDs/LCDs), and regulatory requirements during audits
Prepare detailed audit findings, reports, and documentation to support determinations
Participate in appeal preparation by compiling records, drafting rebuttals, and supporting appeals processes as needed
Communicate audit findings and recommendations to internal stakeholders, including compliance, billing, coding, and clinical teams
Track audit outcomes, trends, and recurring issues to recommend process improvements and risk mitigation strategies
Maintain strict confidentiality and security of protected health information (PHI)
Stay current with Medicare policies, CMS updates, coding changes (ICD-10, CPT, HCPCS), and RAC program requirements
Qualification
Required
High School Diploma / GED
Must be 18 years of age OR older
Working knowledge of Medicare remittance advice, recoupments, and appeals processes, including experience working with Medicare Administrative Contractors (MACs)
Experience with EHR's & practice management systems
Proficient with Microsoft Office (Excel, Word, Outlook, PPT)
Ability to work full time onsite at 5003 Commercial Circle Concord, CA 94520
Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime
Preferred
Experience using Microsoft Word (creating and editing documents), Microsoft Outlook (email and calendar), and Microsoft Excel (filter, edit, sort, creating spreadsheets, basic formulas)
Experience with Epic EHR
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
Optum
Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
Founded in 2011
10001+ employees
H1B Sponsorship
Optum has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (648)
2024 (559)
2023 (620)
2022 (851)
2021 (593)
2020 (438)
Funding
Current Stage
Late StageLeadership Team
Daniel Castillo
Chief Executive Officer, Optum Care Delivery
J
Jay Green
Chief Financial Officer
Recent News
2025-11-29
2025-11-19
2025-11-07
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