Government Audit Recovery Specialist: Corporate Compliance: Temporary

Responsibilities

• Perform duties associated with the Centers for Medicare and Medicaid Services (CMS) Recovery Audit Contractor (RAC) program and other government regulatory and enforcement agency audits for documentation and billing compliance.
• Handle data entry, processing of mail, preparation of audit information, and correspondence with government contractors.
• Respond to correspondence from government agencies related to RAC, Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), Quality Improvement Organizations (QIO), and other Medicaid/Medi-Cal regulatory auditing bodies for pre- and post-payment audits.
• Serve as the focal point for all government audit activity within the organization.

Requirements

• High school diploma or equivalent experience (employees hired prior to 2011 without a HS diploma are grandfathered into their position).
• 3 years of Medicare billing experience in billing, follow-up, or an acute care setting.
• Experience working on complex projects.
• 1-3 years of experience in healthcare acute setting regulatory audits and appeals.
• Experience with and understanding of CMS billing, payment, and reimbursement methodologies.
• Knowledge of privacy regulations, security regulations, release of information, and CMS rules and regulations.
• Proficiency in Microsoft Office applications (Word, PowerPoint, Excel, Outlook).

Preferred Qualifications

• 5 years or more of experience in an acute care setting.
• 3 years of experience in healthcare acute setting regulatory audits and appeals.
• Experience working on government audits, including Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), and other Medicaid/Medi-Cal regulatory audits.
• 5 years of experience in Medicare billing, follow-up, and appeals.
• Knowledge of utilization management process, coding, and medical necessity criteria.
• Certification as a Certified Professional Coder (CPCCS).

About Us

Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers, and a network of more than 1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year.

For over 70 years, Hoag has delivered personalized care in Orange County. Since 1952, Hoag has served local communities and continues its mission to provide the highest quality health care services through core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit, and philanthropy.

Hoag offers specialized care through six institutes: cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health. Hoag was the highest-ranked hospital in Orange County in the 2024-2025 U.S. News & World Report and the only Orange County hospital ranked in the top 10 for California. The organization was ranked #5 in the Los Angeles Metro Area and #10 in California.