Medicare Recovery Audit Specialist

UnitedHealth Group • Concord, CA

8h • $20 - $36 • Hybrid

About The Position

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.

Requirements

• 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 UB‑04 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
• Strong communication skills to clearly convey audit findings and collaborate with clinic managers and physicians on solutions.
• Strong analytical and organizational skills
• 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.

Nice To Haves

• Experience with Epic EHR

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

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED