What are the responsibilities and job description for the Medicare Audit Specialist position at skilledwoundcare?
Job Summary
The 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 Responsibilities
Medicare Collections & Account Resolution
- Manage Medicare accounts receivable for wound care services, including follow-up on underpayments, denials, and unpaid balances
- Monitor Medicare remittance advice (RAs) for takebacks, adjustments, and recoupment activity
- Research and resolve Medicare payment discrepancies related to wound care claims
- Track and reconcile Medicare payment reversals, offsets, and demand letters
Recoupments, Takebacks & Appeals
- Handle Medicare requests for payment takebacks, including RAC, UPIC, SMRC, and MAC-initiated recoupments
Review wound care claims and documentation to determine validity of takeback requests
Coordinate with coding, clinical, and compliance teams to gather supporting documentation - Prepare and submit timely redetermations, reconsiderations, and appeal packets as appropriate
- Track appeal deadlines, outcomes, and recoupment status to minimize cash flow disruption
- Communicate with Medicare Administrative Contractors (MACs) regarding recoupment resolution
- Provide feedback to providers and billing teams to prevent repeat recoupments
Reporting & Compliance
- Maintain detailed documentation of Medicare collection and recoupment activity
- Prepare reports on Medicare A/R, takebacks, appeal success rates, and trends
- Ensure compliance with CMS billing, appeals, and collections regulations
- Assist with process improvement initiatives to reduce Medicare payment risk
Required Qualifications
- 2 years of experience in Medicare collections, billing follow-up, or revenue cycle management
- Strong working knowledge of Medicare remittance advice, recoupments, and appeal processes
Experience working with Medicare Administrative Contractors (MACs) - Proficiency with EHRs, practice management systems, and Microsoft Office (Excel, Word, Outlook)
- Strong analytical, organizational, and communication skills
Preferred Qualifications
- Associate’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 centers
- Knowledge of wound care coding and coverage requirements (CPT, HCPCS, ICD-10)
CPC, CCS, or similar coding certification - Experience managing RAC, UPIC, or SMRC recoupments and appeals
- Strong understanding of Medicare collections workflows
- Attention to detail and deadline management
- Effective written and verbal communication with payers and internal teams
- Problem-solving and appeal strategy skills
- High level of integrity and confidentiality
- Must reside in the US and be authorized to work in the US
Benefits
- Competitive compensation, Medical, Dental, Vision, 401K, PTO.
- Potential performance-based bonus
- Full-time remote position
Pay
- $20.00-25.00/hour based on experience/education
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