Program Manager - Medicare Recovery Audit Validation

Overview

Remote
Depends on Experience
Full Time

Skills

Artificial Intelligence
RAC
Medicare
Natural Language Processing
Medical Records
audit determinations
program manager
project manager
CMS
Medicare & Medicaid
Auditing
Quality Assurance

Job Details

Title: Program Manager (Medicare Recovery Audit Validation)

Location: Remote United States

Company Background

A P Ventures, LLC (APV) is an innovative Woman-Owned Small Business (WOSB) providing services to Government customers at the federal and state levels in three key focus areas: High-End IT Consulting, Emerging Technology and Training Solutions, and Human Capital Services. Established in 2007, APV has completed 70+ prime contracts and currently oversees 25+ task orders, consistently achieving high client satisfaction, CPARS, and customer accolades. Our success is fueled by our skilled and motivated workforce, reflected in our impressive employee retention rate exceeding 90%. APV has a wide portfolio of contracts and Best-in-Class contract vehicles, including GSA MAS, OASIS Small Business, and 8(A) Pool 1, CIO-SP3 SB & 8(a) across all functional areas, HCaTS, and several other industry-specific BPA and IDIQs.

APV is a mature company dedicated to quality and exceptional delivery to meet its clients missions. We understand personnel are an essential part of this. We hire the best and take care of the people who come to work for us. We continue to maintain employee satisfaction and have a high retention rate, well above the industry average for our small business peers. We do this through our corporate practice that emphasizes on employee satisfaction through the three C s Culture, Compensation, and Career Development.

Role:

  • Manage RAC determination validation reviews across Medicare Fee for Service (FFS) claims.
  • Lead team performing medical record audits and clinical determinations.
  • Produce CMS reports on RAC accuracy, error rates, and policy recommendations.
  • Oversee quality assurance reviews and corrective action plans.
  • Integrate advanced tools to streamline and augment medical review processes.

Education:

  • Bachelor s degree in public health, health administration, nursing, or a related field, required.
  • Master s degree in public health, health administration, nursing, or a related field preferred.

Required Skills:

  • 10+ years of Medicare audit validation or recovery audit experience.
  • Clinical credential (e.g., RN, CPC, MD) and experience managing audit teams.
  • Working knowledge of RACDW, NCD/LCD application, and CMS audit protocols.

Preferred Experience and Skills

  • Previous experience with CMS RAC or RVC contracts.
  • Familiarity with NLP or AI systems to augment medical review.

About A P Ventures

A P Ventures is an Equal Employment Opportunity employer. All qualified applicants are considered without regard to race, national origin, gender, age, religion, disability, sexual orientation, veteran status, or marital status. Minorities/Females/Veterans/Disability candidates are encouraged to apply. Qualified military veterans are encouraged to apply.

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