Medicare Collections & Recoupment Specialist

Medicare Collections & Recoupment Specialist Job Summary The Medicare Collections & Recoupment Specialist is responsible for managing Medicare accounts receivable, with a primary focus on payment takebacks, recoupments, and demand letters issued by Medicare. This role ensures timely response to Medicare payment adjustments, appeal determinations, and recoupment activity related to wound care services. The specialist works closely with billing, coding, clinical, and compliance teams to protect revenue while maintaining compliance with CMS and MAC requirements.

Key Responsibilities Medicare Collections & Account Resolution

Manage Medicare accounts receivable for wound care services, including follow-up on underpayments, denials, and unpaid balances

Monitor Medicare remittance advice (RAs) for takebacks, adjustments, and recoupment activity

Research and resolve Medicare payment discrepancies related to wound care claims

Track and reconcile Medicare payment reversals, offsets, and demand letters

Recoupments, Takebacks & Appeals

Handle Medicare requests for payment takebacks, including RAC, UPIC, SMRC, and MAC-initiated recoupments Review wound care claims and documentation to determine validity of takeback requests Coordinate with coding, clinical, and compliance teams to gather supporting documentation

Prepare and submit timely redeterminations, reconsiderations, and appeal packets as appropriate

Track appeal deadlines, outcomes, and recoupment status to minimize cash flow disruption

Communicate with Medicare Administrative Contractors (MACs) regarding recoupment resolution

Provide feedback to providers and billing teams to prevent repeat recoupments

Reporting & Compliance

Maintain detailed documentation of Medicare collection and recoupment activity

Prepare reports on Medicare A/R, takebacks, appeal success rates, and trends

Ensure compliance with CMS billing, appeals, and collections regulations

Assist with process improvement initiatives to reduce Medicare payment risk

Required Qualifications

2+ years of experience in Medicare collections, billing follow-up, or revenue cycle management

Strong working knowledge of Medicare remittance advice, recoupments, and appeal processes Experience working with Medicare Administrative Contractors (MACs)

Proficiency with EHRs, practice management systems, and Microsoft Office (Excel, Word, Outlook)

Strong analytical, organizational, and communication skills

Preferred Qualifications

Associate’s or Bachelor’s degree in Healthcare Administration, Health Information Management, Business, or related field (or equivalent experience)

Experience in outpatient wound care, specialty clinics, or hospital-based wound centers

Knowledge of wound care coding and coverage requirements (CPT, HCPCS, ICD-10) CPC, CCS, or similar coding certification

Experience managing RAC, UPIC, or SMRC recoupments and appeals

Strong understanding of Medicare collections workflows

Attention to detail and deadline management

Effective written and verbal communication with payers and internal teams

Problem-solving and appeal strategy skills

High level of integrity and confidentiality

Must reside in the US and be authorized to work in the US

Potential performance-based bonus

Full-time remote position

Pay

$20.00-25.00/hour based on experience/education

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