AUDITOR, RAC

Location
Virginia Beach, VA
Posted
Jul 12, 2017
Closes
Aug 01, 2017
Function
Audit and Tax
Industry
Healthcare
Hours
Full Time
Job Description: The Recovery Audit Contractor (RAC) Auditor is responsible for determining that the ICD 9, ICD 10 and CPT coding is supported by the clinical documentation in the medical record. 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 auditors for corporate audits.

Education Level
Associate's Level Degree - HEALTH INFORMATION MANAGEMENT - Experience in lieu of education: Yes OR
Bachelor's Level Degree - HEALTH INFORMATION MANAGEMENT - Experience in lieu of education: Yes

Experience
Required: Coding - 5 years

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

License
Required: Cert Coding Specialist, Cert Professional Coder

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

Skills
Required: Communication, Coordination, Critical Thinking, Microsoft Office, Monitoring, Reading Comprehension, Service Orientation, Technology/Computer, Writing

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

Other
Associates in HIM or 2 years in lieu of degree or Bachelor's In HIM degree or 4 years experience in lieu of degree required. 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. Previous Healthcare Auditing experience preferred