Medicare Collections & Recoupment Specialist

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 Must be authorized to work in the US

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 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 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