Medicare Audit Specialist

Skilled Wound Care•Los Angeles, CA

9h•$20 - $25•Remote

About The Position

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

Requirements

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
Must reside in the US and be authorized to work in the US

Nice To Haves

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

Responsibilities

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
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
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