Clinical RAC Auditor
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Job Location:
Norfolk, MA - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
City/State
Norfolk VAWork Shift
First (Days)Overview:
Recovery Audit Contractor (RAC)
The Recovery Audit Contractor (RAC) Auditor is responsible for determining the clinical necessity that supports the claim in accordance with the respective contract while also coordinating the disposition of the denied claim with the appropriate personnel.
- Must demonstrate an understanding of Medicare and other payer guidelines related to billing and charging of observation services other separately chargeable services and other lines of service.
- Must demonstrate knowledge of managed care contracting arrangements as well as notification and clinical review requirements.
- Must also be knowledgeable of regulatory and compliance requirements for government payers regarding clinical reviews and medical necessity. Possess the ability to perform a number of functions including those of internal auditing coder education liaison with external auditors for corporate audits.
- Registered Nurse license required.
Demonstrates the minimum knowledge skills and abilities to recognize for the individualized needs of the patient to include physical psychological socio-cultural spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices. Ability to understand and interpret medical records hospital bills and Charge Master.
Must demonstrate an understanding of Medicare and other payer guidelines related to billing and charging of observation services other separately chargeable services and other lines of service. Must demonstrate knowledge of managed care contracting arrangements as well as notification and clinical review requirements. Must also be knowledgeable of regulatory and compliance requirements for government payers regarding clinical reviews and medical necessity.
CPC or CCS required within 6 months of hire. Previous Healthcare Auditing experience preferred.
Education
- RN Bachelor Level Degree
- 2 yr RN Associate Degree
- RN Diploma
Certification/Licensure
- CPC or CCS required within 6 months of hire.
- Previous Healthcare Auditing experience preferred
Experience
- Demonstrates the minimum knowledge skills and abilities to recognize for the individualized needs of the patient to include physical psychological socio-cultural spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices
- Ability to understand and interpret medical records hospital bills and Charge Master.
- Must demonstrate an understanding of Medicare and other payer guidelines related to billing and charging of observation services other separately chargeable services and other lines of service.
- 5 years Acute Care Coding experience required
- Registered Nurse required
Registered Nurse Coding Acute Care Medicare
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30000-member workforce. Diversity inclusion and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission to improve health every day this is a tobacco-free environment.
For positions that are available as remote work Sentara Health employs associates in the following states:
Alabama Delaware Florida Georgia Idaho Indiana Kansas Louisiana Maine Maryland Minnesota Nebraska Nevada New Hampshire North Carolina North Dakota Ohio Oklahoma Pennsylvania South Carolina South Dakota Tennessee Texas Utah Virginia Washington West Virginia Wisconsin and Wyoming.
Key Skills
- Auditing
- Time Management
- ICD-10
- Accounting
- Component evaluation
- Workers' Compensation Law
- SOX
- Microsoft Excel
- CPT Coding
- Internal Audits
- Medicare
- Bookkeeping
About Company
Sentara Health, is an integrated, not-for-profit health care delivery system in Virginia and North Carolina. Sentara improves health everyday.
