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Remote Recovery Audit Contractor Jobs in Tennessee

Uber AI Solutions

Legal Counsel - Freelance

Nashville, TN · Remote

$100 - $120/hr

We partner with independent contractors to support large-scale model evaluation, alignment, and ... Audit complex legal outputs to identify errors in logic or jurisdictional nuance. * Root-Cause ...

Uber AI Solutions

Legal Counsel - Freelance

Memphis, TN · Remote

$100 - $120/hr

We partner with independent contractors to support large-scale model evaluation, alignment, and ... Audit complex legal outputs to identify errors in logic or jurisdictional nuance. * Root-Cause ...

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Remote Recovery Audit Contractor information

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 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 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 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.
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Remote Recovery Audit Contractor jobs near you
Audit Specialist II

Audit Specialist II

Health Care Service Corporation

Nashville, TN • Remote

$41K - $92K/yr

Full-time

Medical, Life, Retirement, PTO

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job SummaryThe Audit Specialist Analyst II is responsible for independently executing internal and external audits, interpreting audit findings, validating compliance with contractual performance guarantees, and supporting broader quality assurance initiatives. This role requires advanced knowledge of Affordable Care Act, Commercial, Medicare and Medicaid reimbursement methodologies, including facility, ancillary, and professional claims, as well as the ability to analyze claim calculations, interpret provider contracts, collaborate with cross-functional teams, and identify opportunities to improve audit accuracy, compliance, and operational performance.

Required Job Qualifications:

  • Bachelor's degree or equivalent experience in claims processing or audit.

  • 2 years in audit or claims review.

  • Familiarity with adjudication systems.

  • Proficient in Microsoft Office and audit software.

  • Strong analytical and communication skills.

Preferred Job Qualifications:

  • Experience in payment integrity or provider contracting - HIGHLY PREFERRED

  • Extensive experience across ACA, Commercial, Medicare, and Medicaid plans, including reimbursement methodologies and payment structures

  • Strong expertise in facility, ancillary, and professional billing, coding, and reimbursement practices

  • Proven ability to interpret provider contracts and perform detailed claim reviews, calculations, and variance analysis

  • Advanced analytical, critical thinking, and problem-solving skills to assess risks and recommend corrective actions

  • Excellent communication and collaboration skills, with the ability to present findings, manage priorities independently, and partner effectively across stakeholders

Sponsorship will not be provided for this role.

This is a Telecommute (Remote) role.

#LI-LI1

#LI-Remote

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$41,700.00 - $92,800.00

Exact compensation may vary based on skills, experience, and location.

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