Medicare Audit Specialist

Job SummaryThe Medicare Audit Specialist is responsible for managing Medicare accounts receivable, with a primary focus on payment takebacks, recoupments, and demand letters issued by Medicare. This role ensures timely response to Medicare payment adjustments, appeal determinations, and recoupment activity related to wound care services. The specialist works closely with billing, coding, clinical, and compliance teams to protect revenue while maintaining compliance with CMS and MAC requirements. The Medicare Audit Specialist will identify root cause issues, overpayments and assist with review and responses for Health Plan Audits.CANDIDATE MUST BE BASED IN THE US Key ResponsibilitiesMedicare Collections & Account ResolutionManage Medicare accounts receivable for wound care services, including follow-up on underpayments, denials, and unpaid balancesMonitor Medicare remittance advice (RAs) for takebacks, adjustments, and recoupment activityResearch and resolve Medicare payment discrepancies related to wound care claimsTrack and reconcile Medicare payment reversals, offsets, and demand lettersRecoupments, Takebacks & AppealsHandle Medicare requests for payment takebacks, including RAC, UPIC, SMRC, and MAC-initiated recoupmentsReview wound care claims and documentation to determine validity of takeback requestsCoordinate with coding, clinical, and compliance teams to gather supporting documentationPrepare and submit timely redetermations, reconsiderations, and appeal packets as appropriateTrack appeal deadlines, outcomes, and recoupment status to minimize cash flow disruptionCommunicate with Medicare Administrative Contractors (MACs) regarding recoupment resolutionProvide feedback to providers and billing teams to prevent repeat recoupmentsReporting & ComplianceMaintain detailed documentation of Medicare collection and recoupment activityPrepare reports on Medicare A/R, takebacks, appeal success rates, and trendsEnsure compliance with CMS billing, appeals, and collections regulationsAssist with process improvement initiatives to reduce Medicare payment riskRequired Qualifications2 years of experience in Medicare collections, billing follow-up, or revenue cycle managementStrong working knowledge of Medicare remittance advice, recoupments, and appeal processesExperience working with Medicare Administrative Contractors (MACs)Proficiency with EHRs, practice management systems, and Microsoft Office (Excel, Word, Outlook)Strong analytical, organizational, and communication skillsPreferred QualificationsAssociate's or Bachelor's degree in Healthcare Administration, Health Information Management, Business, or related field (or equivalent experience)Experience in outpatient wound care, specialty clinics, or hospital-based wound centersKnowledge of wound care coding and coverage requirements (CPT, HCPCS, ICD-10)CPC, CCS, or similar coding certificationExperience managing RAC, UPIC, or SMRC recoupments and appealsStrong understanding of Medicare collections workflowsAttention to detail and deadline managementEffective written and verbal communication with payers and internal teamsProblem-solving and appeal strategy skillsHigh level of integrity and confidentialityMust reside in the US and be authorized to work in the USBenefitsCompetitive compensation, Medical, Dental, Vision, 401K, PTO.Potential performance-based bonusFull-time remote positionPay$20.00-25.00/hour based on experience/education#ZR

Salary : $20 - $25