AUDITOR, RAC - CLINICAL

Location
Virginia Beach, VA
Posted
Jul 12, 2017
Closes
Aug 03, 2017
Function
Audit and Tax
Industry
Healthcare
Hours
Full Time
Job Description: 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, 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 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. All new RN's who do not have their BSN will be required to sign a BSN Agreement committing to enrollment in an accredited RN to BSN program within 24 months of hire and successfully obtaining their BSN within 5 years of hire.