Recovery Audit Contractor; RAC Coordinator; RN

Recovery Audit Contractor (RAC) Coordinator (RN) Overview

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The Recovery Audit Contractor (RAC) Coordinator (RN) is responsible and accountable for all Care Management Denial and Recovery Audit Contractor (RAC) requests and follow‑ups, including tracking of approvals and denials as well as coordinating and completing the appeal process.

• Coordinates the denial and RAC process, including requests, follow‑ups, tracking of approvals and denials, and completing appeals. Oversees and maintains the denial and RAC request/response databases; ensures the timeliness of the response/submission of records and outcomes. Works with EHR to file appeals and coordinate the follow‑up with EHR. Handles all denial and RAC requests from receipt of the letter until charts are finalized as approved or denied.
  
  Ensures proper implementation of RAC process.
• Communicates effectively with administration and management, members of the medical staff, patient care services and ancillary departments, and all affected external entities involved in the denial/RAC process. Serves as liaison between the organization and Care Management regarding the Denial/RAC process, including all related concerns and actions. Documents activities, events, and information per standards in established software systems in a timely, accurate, and complete manner.
• Develops and maintains policies and procedures for the denial/RAC process; evaluates the process to ensure effectiveness of current policies and procedures and makes recommendations to further develop the process as needed. Provides statistics and reports to administration, UR Committee, and any other committee as requested by management. Provides education to care managers, coders and physicians regarding CMS updates, changes, etc.

• Must be licensed to practice as a Registered Nurse in the state of North Carolina or one of the compact states.
• Two (2) years of experience working as a Registered Nursing in an acute care inpatient setting, including expertise and extensive knowledge of complex disease processes.
• Excellent verbal and written communication.
• Basic Life Support (BLS) certification.

• Experience working in a care / case management capacity.
• Certified Case Manager (CCM) as issued by the Commission for Case Manager Certification (CCMC).

Legal

Employer:

Pardee – HCHC
Entity:
Pardee UNC Health Care
Organization Unit:
Acute Care Case Management
Work Type:
Per Diem
Standard Hours Per Week: 0.20
Work Assignment Type:
Remote

Work Schedule:

Day Job
Location of Job: PARDEEHOSP
Exempt From Overtime:
Exempt:
No
Job :

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran, or political affiliation.