Medicare Recovery Audit Specialist

This position follows a hybrid schedule with 1 in-office day per week. Our office is located at 5003 Commercial Circle, Concord, CA 94520.

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

The Medicare Recovery Audit Specialist is responsible for identifying and addressing improper Medicare payments through retrospective claims review. This role ensures compliance with Medicare regulations, CMS guidelines, and internal policies by analyzing medical records, billing data, and coding accuracy. The Specialist works collaboratively with internal departments to support audit responses, appeals, and compliance improvement initiatives.

This position is 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 8:00 am - 5:00 pm.

This will be on the job training and the hours during training will be during normal Business hours

Primary 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

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED
• Must be 18 years OR older
• Working knowledge of Medicare remittance advice, recoupments, and appeals processes, including experience working with Medicare Administrative Contractors (MACs)
• Experience with CMS/Medicare billing, including UB04 form requirements and CMS/Medicare policies
• Experience with Electronic Health Records (EHR) & Practice Management Systems (PMS)
• Proficient with Microsoft Office (Microsoft Excel, Microsoft Word, Microsoft Outlook, Microsoft Powerpoint)
• Ability to work onsite one day per week at 5003 Commercial Circle, Concord, CA 94520, with the remaining days worked remotely
• 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 8:00 am - 5:00 pm

Preferred Qualifications:

• Experience with Epic EHR

Telecommuting Requirements:

• Reside within commutable distance to the office at 5003 Commercial Circle, Concord, CA 94520
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

• Strong communication skills to clearly convey audit findings and collaborate with clinic managers and physicians on solutions.
• Strong analytical and organizational skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.38 - $36.44 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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