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Remote Recovery Audit Contractor Jobs in New York

EmblemHealth

Lead Audit Specialist - Remote

New York, NY · On-site +1

$77.76K - $149.04K/yr

Manage external Medicare, Medicaid (including Child Health Plus) and commercial product-related audit efforts, including audits from CMS and its audit contractors/consultants, HHS OIG, NYS DOH, NYS ...

Mercor

Audit Professional - Fully Remote

New York, NY · Remote

$60 - $85/hr

Position: Audit Expert Type: Contract Compensation: $60-$85/hour Location: Remote Role ... Hourly contractor , Paid weekly via Stripe Connect . Application Process (Takes 20-30 mins to ...

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Remote Recovery Audit Contractor information

What are the key skills and qualifications needed to thrive as a Remote Recovery Audit Contractor, and why are they important?

To thrive as a Remote Recovery Audit Contractor, you need expertise in healthcare claims auditing, knowledge of Medicare/Medicaid regulations, and a relevant degree such as in health information management or accounting. Familiarity with audit software, medical coding systems (like ICD-10 and CPT), and data analysis tools is typically required. Strong analytical thinking, attention to detail, and effective written communication are essential soft skills for identifying discrepancies and reporting findings. These skills are crucial for ensuring accuracy in claim reviews, detecting improper payments, and supporting compliance in remote healthcare environments.

What are the main challenges faced by a Remote Recovery Audit Contractor and how can they be overcome?

Remote Recovery Audit Contractors often face challenges such as accessing and analyzing large volumes of healthcare or financial data from diverse sources, ensuring compliance with privacy regulations, and maintaining clear communication with clients and team members. To overcome these, it's important to develop strong organizational and analytical skills, stay updated on industry regulations, and leverage secure collaboration tools. Regular virtual meetings and proactive communication also help in aligning with stakeholders and resolving discrepancies efficiently.

What are Remote Recovery Audit Contractors?

Remote Recovery Audit Contractors are professionals or firms hired to review financial transactions, such as medical claims or vendor payments, to identify and recover overpayments or incorrect payments. They work remotely, using specialized software and data analysis techniques to audit large volumes of records for potential errors or discrepancies. These contractors are commonly used by healthcare organizations, insurance companies, and government agencies to ensure compliance and recover lost funds. Their findings can help organizations improve their payment processes and prevent future mistakes.

What is the difference between Remote Recovery Audit Contractor vs Remote Healthcare Auditor?

AspectRemote Recovery Audit ContractorRemote Healthcare Auditor
CredentialsCPAR certification often preferredCPAR, CHAP, or similar healthcare-specific certifications
Work EnvironmentRemote, contract-based, healthcare industryRemote, healthcare industry focus
Employer & Industry UsageHealthcare payers, government agencies, insurance companiesHospitals, healthcare providers, insurance companies
Primary FocusIdentifying and recovering overpaid healthcare claimsAuditing healthcare records and billing for compliance

The main difference is that a Remote Recovery Audit Contractor primarily focuses on recovering overpaid healthcare claims through audits, while a Remote Healthcare Auditor reviews healthcare records and billing for compliance and accuracy. Both roles require healthcare industry knowledge and certifications but serve different functions within healthcare finance and compliance.

What are popular job titles related to Remote Recovery Audit Contractor jobs in New York? For Remote Recovery Audit Contractor jobs in New York, the most frequently searched job titles are:
What job categories do people searching Remote Recovery Audit Contractor jobs in New York look for? The top searched job categories for Remote Recovery Audit Contractor jobs in New York are:
What cities in New York are hiring for Remote Recovery Audit Contractor jobs? Cities in New York with the most Remote Recovery Audit Contractor job openings:
Remote Recovery Audit Contractor jobs near you
Manager, Benefits Coordination and Claims

Manager, Benefits Coordination and Claims

EmblemHealth

New York, NY • Remote

Other

Medical

Posted 6 days ago

Job description

REMOTE

Summary of Position

  • Responsible for leading and optimizing the organization's secondary payer and revenue recovery processes across all lines of business, establishing performance metrics and accountability standards aligned with organizational goals.
     
  • Lead, supervise, and develop a team of COB Specialists, establishing performance metrics and accountability standards aligned with organizational goals
     
  • Ensure accurate identification and management of Other Health Insurance (OHI), compliance with CMS and regulatory requirements, and operational excellence within COB functions.
     
  • Monitor and analyze COB metrics, denial trends, and recovery outcomes; implement process improvements to enhance operational effectiveness.
     
  • Drive strategic initiatives to reduce claim overpayment, improve recovery outcomes, and strengthen financial performance while maintaining regulatory integrity.


Principal Accountabilities

  • Oversee end-to-end COB operations, including identification and validation of Other Health Insurance (OHI), Medicare Secondary Payer (MSP) processing, and commercial coordination rules. Ensure accurate application of Medi Investigate and resolve complex COB claim denials, payment disputes, and escalated provider or member inquiries.
     
  • Ensure accurate application of Medicare, Medicaid, Essential Plan, Exchange, and Commercial Group Health Plan COB rules.
     
  • Ensure full compliance with Centers for Medicare & Medicaid Services (CMS) regulations, including Medicare Secondary Payer (MSP) requirements, and Section 111 quarterly filings.
     
  • Maintain adherence to federal and state COB regulations across all product lines, including Medicaid and Exchange plans.
     
  • Investigate and resolve complex COB claim denials, payment disputes, and escalated provider or member inquiries.
     
  • Identify root cause of issues and work with internal teams to improve processes and close process gaps.
     
  • Collaborate and work cross-functionally with other operational areas (Claims, Provider Network Management, Contract Configuration, Provider File Operations, Payment Integrity, etc.) to ensure root causes are remediated for both overpayment and underpayments.
     
  • Lead internal and external compliance audits and regulatory obligations.
     
  • Implement corrective action plans in response to audit findings, regulatory updates, or compliance reviews.
     
  • Support internal and external audits by maintaining accurate documentation, policies, and standard operating procedures.
     
  • Partner with Claims, Enrollment, Finance, Compliance, and IT to ensure data integrity, accurate eligibility verification, and system optimization.
     
  • Responsible for vendor relationships and recovery audit processes, as applicable.
     
  • Develop and deliver ongoing team training to ensure regulatory updates, policy changes, and system enhancements are effectively implemented.
     
  • Perform other duties as assigned or required.

Qualifications

  • 5 - 8+ years' relevant work experience in claims operations within a health insurance carrier environment required
     
  • Bachelor's degree required; additional experience/specialized training may be considered in lieu of degree
     
  • Demonstrated expertise in Medicare, Medicaid, Essential Plan, Exchange, and Commercial Group Health Plan Coordination of Benefits rules required
     
  • 5+ years' experience managing staff / processes required
     
  • In-depth knowledge of HIPAA regulations and CMS guidelines, including Medicare Secondary Payer requirements required
     
  • Strong understanding of COB investigative processes, overpayment recovery methodologies, and denial management required
     
  • Proficiency with claims processing platforms such as Facets and related eligibility and enrollment systems required
     
  • Advanced analytical skills with the ability to interpret claims data, identify trends, and implement corrective strategies required
     
  • Excellent communication and leadership skills with the ability to drive accountability and cross-functional collaboration required
     
  • Strong organizational and auditing skills and attention to detail with a focus on operational efficiency and compliance integrity required
     
  • Ability to effectively organize, prioritize, and manage multiple tasks/projects with simultaneous conflicting deadlines required
     
  • Strong analytic, decisionmaking, and problemsolving abilities required
     
  • Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required
     
  • Demonstrated leadership skills in a matrix environment required
     
  • Ability to discern and identify patterns/trends of issues and provide recommendations for resolution required
Additional Information
  • Requisition ID: 1000003153
  • Hiring Range: $77,760-$149,040

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