Coordinator, RAC Program

Description

Summary:
Coordinates all Recovery Audit Contractor activities and PRO requests within Wayne UNC Health Care environment. Prepares agenda for the Denials Management Team and creates and maintains data bases containing all pertinent information relative to auditor requests, reviews, appeals, and outcomes. Develops and maintains statistical reports and other data as required.

Responsibilities:
1.Coordinates some of the functions performed by the HIM Data Analysts relative to the RAC process.
2.Maintains accurate and thorough policies and procedures for the RAC program.
3.Communicates and confers with members of the health care team as needed to adequately respond to RAC or PRO denials. Tracks and reports on the status of RAC activity timely and accurately.
4.Serves as a resource to hospital staff, physician's office staff and may provide education on request or a needed. Keeps current on new or changing regulations.
5.Collaborates with charging and billing areas to ensure compliance with Federal and State regulations and continuous quality improvement.
6.Prepares agenda and maintains minutes of the Denials Management Team.
7.Files or scans IRB documents for tracking purposes through the period required for closure of protocols.
8.Assists with preparation of department budget, strategic initiatives and goals.
9.Maintains IRB minutes.
10.Participates in performance improvement and continuous improvement activities.

Other information:
Education
Associate degree.
Will consider experience in lieu of degree if candidate is enrolled in a degree program at the time of application.

Licensure/Certification
None.

Experience
*Minimum of five years experience in HIM or related health care field.
*Two or more years experience in supervisory position preferred.

Knowledge, Skills and Abilities
*Extensive knowledge of medical terminology, anatomy and physiology and the disease process.
*Knowledge of CMS, state and federal regulations and accrediting agency standards.
*Extensive knowledge of ICD-9-CM and CPT coding systems required.
*Ability to research, interpret and develop recommendations.
*Strong data analysis, follow up and problem solving skills.
*Ability to read, write and communicate effectively in English.
*Proficient with MS Office and able to learn new software rapidly.

Valid NC Driver's License: No
If driving a Wayne UNC Vehicle, must be 21 years old and MVR must be approved by Risk Management.

BO-206

Legal Employer: Wayne Health

Entity: Wayne UNC Health Care

Organization Unit: Health Information Mgmt

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: WAYNE MED

Exempt From Overtime: Exempt: No

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.