Clinical RAC Auditor

Location
Virginia Beach, VA
Posted
May 09, 2016
Closes
May 12, 2017
Function
Audit and Tax
Industry
Healthcare
Hours
Full Time
Job Description:
Sentara Healthcare is recruiting for an experienced full-time Clinical RAC Auditor. We are offering up to a $3,000.00 Sign-on bonus for qualified candidate. Ability to work part-time from home after successful training that is done at our HIS Landstown location in Virginia Beach, VA. This position is responsible for determining that the ICD 9, ICD 10 and CPT coding is supported by the clinical documentation in the medical record. Also review and validate medical necessity information from CMS Local Coverage Determination (LCD) with medical record documentation. Must be a proficient coder with thorough knowledge of coding guidelines and coding clinics. Primary function is the ability to write a complete comprehensive appeal to support claims coded appropriately. Also performs a number of functions including those of internal auditing, coder education, physician documentation education, liaison with external coding auditors and insurance companies.

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.

Education Level
RN-Associate's Degree OR
RN-Bachelor's Level Degree OR
RN-Diploma (Non-degree)

Experience
Required: Acute Care - 5 years, Coding - 5 years

Preferred: None, unless noted in the “Other” section below

License
Required: Cert Coding Specialist, Cert Professional Coder, Registered Nurse

Preferred: None, unless noted in the “Other” section below

Skills
Required:

Preferred:

Other
Registered Nurse license required. Demonstrates the minimum knowledge, skills and abilities to recognize for the individualized needs of the patient to include physical, psychological, sociocultural, 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 ChargeMaster. 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.