Description
Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.
Summary:
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.
Responsibilities:
• Coordinates the Denial and RAC process, including requests, follow-ups, tracking of approvals and denials, and completing appeals. Oversees/maintains the denial and RAC request/response data bases; ensures the timeliness of the response/submission of records and outcomes. Works with EHR to file appeals and coordinate the follow up with EHR. Coordinates all activities associated with denial and RAC requests, appeals, etc. Handles all the denial and RAC requests from the time the letter is received until all charts are finalized either as approved or denial. Ensures proper implementation of RAC process.
• Communicate effectively with administration and management, members of the medical staff, patient care services and ancillary departments, as well as all affected external entities, involved in the denial/RAC process. Serves as the liaison between the organization and Care Management regarding Denial/RAC process, including all related concerns and actions. Documentation - 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.
Other information:
Qualifications
Required
• Must be licensed to practice as a Registered Nurse in the state of North Carolina or one of 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
Preferred
• Experience working in a care / case management capacity.
• Certified Case Manager (CCM) as issued by the Commission for Case Manager Certification (CCMC).
Job Details
Legal Employer: Pardee - HCHC
Entity: Pardee UNC Health Care
Organization Unit: Acute Care Case Management
Work Type: Per Diem
Standard Hours Per Week: 8.00
Work Assignment Type: Hybrid
Work Schedule: Day Job
Location of Job: PARDEEHOSP
Exempt From Overtime: Exempt: No
