The Government Recovery Specialist performs duties associated with 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. This includes data entry, processing of mail, preparation of audit information, and correspondence with government contractors as needed.
This role has a fundamental understanding of the RAC program and other audits for documentation and billing compliance. As an essential role and focal point of all government audit activity, the Government Recovery Specialist is responsible for responding to correspondence from Government Agencies related to Recovery Audit Contractor (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 body for pre and post payment audits.
QualificationsEducation and Experience- 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, in 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, CMS rules and regulations
- Proficiency in Microsoft Office applications (Word, PowerPoint, Excel, Outlook).
- 5 years of experience or more in an acute setting
- 3 years of experience in healthcare acute setting regulatory audits and appeals
- Experience working on government, 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 and other regulatory audits
- 5 years of experience in Medicare billing, follow up, appeals
- Knowledge of utilization management process, coding, medical necessity criteria
N/A
License PreferredN/A
Certifications RequiredN/A
Certifications Preferred- CPC
- CCS
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 than1,800 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 a level of personalized care that is unsurpassed among Orange County’s health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy.
Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes.
Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California.
To learn more about Hoag’s awards and accreditations, visit: https://www.hoag.org/about-hoag/awards-accreditations/.
Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.
Skills Required
- High school diploma or equivalent
- 3 years of Medicare billing experience in billing and follow up in an acute care setting
- Experience working on complex projects
- 1-3 years of experience in healthcare acute setting regulatory audits and appeals
- Understanding of CMS billing, payment and reimbursement methodologies
- Knowledge of privacy regulations, security regulations, release of information, CMS rules and regulations
- Proficiency in Microsoft Office applications (Word, PowerPoint, Excel, Outlook)
- 5+ years of experience in an acute setting
- Experience with RAC, MAC, TPE, CERT, OIG, QIO, Medicaid, Medi-Cal and other government audits
- 5 years of experience in Medicare billing, follow up, appeals
- Knowledge of utilization management process, coding, medical necessity criteria
- CPC certification
- CCS certification
Hoag Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Hoag and has not been reviewed or approved by Hoag.
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Healthcare Strength — Health, dental, vision, mental health, disability, and wellness programs are extensive, with additions like FSAs and pet insurance. These offerings are presented as comprehensive and a meaningful component of total rewards.
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Leave & Time Off Breadth — Generous PTO, paid holidays and sick time, and parental leave feature prominently. These time-off provisions are described as supportive of work-life balance across roles, including fellowship programs.
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Career-Linked Recognition & Rewards — Tuition reimbursement, continuing education stipends, certification bonuses, and a clinical ladder link development to higher pay and broader involvement. Promote-from-within practices further connect performance and growth to compensation over time.
Hoag Insights
What We Do
Since 1952, Hoag has been serving the local communities of Orange County by providing personalized health care services of an unsurpassed level. Hoag Digital Health is a new customer-centric product management, design, and engineering unit on a mission to bring together Hoag's nationally renowned care in key medical specialties with the everyday experience of primary, urgent, and preventative care and well-being through a variety of digital mediums.
Why Work With Us
To date, we have been helping fundamentally rethink the care experience for multiple customer groups with hybrid digital-physical solutions – from becoming go-to guides for first-time parents delivering at Hoag through re-imagining the primary care and annual wellness experience to improving Hoag’s “digital front doors,” including its websites.
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