RAC & Payer Audit Coordinator

Lexington Medical Center

12d

About The Position

Responsible for coordinating, tracking and following up on all payer audit record requests, audit responses and appeals for the CMS Recovery (RAC) Program, CMS Medicaid Integrity Program, as well as all other Managed Care payer reviews for medical necessity, DRG and coding validation.

Requirements

• Minimum Education: High School Diploma or Equivalent
• Minimum Years of Experience: 3 Years of experience hospital business office or medical setting and/or six months successful experience as a Business Office Associate.
• Substitutable Education & Experience: None.
• Required Certifications/Licensure: None.
• Required Training: General knowledge of medical ethics and confidentiality;
• Extensive knowledge of medical terminology, ICD-9/ICD-10, and CPT coding;
• Personal computer proficiency with an emphasis on accuracy;
• Ability to manipulate data in spreadsheets (i.e. Microsoft Excel) in order to report trends/patterns/statuses or abuses.

Responsibilities

• Receives, logs and tracks all RAC, MAC, CERT, other Government payer audit and Managed Care payer audit activity and correspondence.
• Works collaboratively with the Medical Records Department and ROI vendor to coordinate the sending and tracking of all medical record requests related to payer audits.
• Works collaboratively with the appropriate personnel and departments to facilitate timely appeal of payer audit denials.
• Follows up on outstanding medical record, audit requests and appeals to ensure they are responded to and resolved in a timely manner.
• Escalates status requests on account audits or appeals via monthly operational conference calls, as needed.
• Assists with preparation of audit activity reports on a monthly basis.
• Ensures proper documentation of activity or progress in EPIC and Payer Audit tracking software to  ensure that anyone viewing accounts will be aware of current status.
• Makes adjustments to account balances as appropriate and resolves secondary refunds needed in a timely manner.
• Performs all other duties as assigned.

Benefits

• Day ONE medical, dental and life insurance benefits
• Health care and dependent care flexible spending accounts (FSAs)
• Employees are eligible for enrollment into the 403(b) match plan day one.  LHI matches dollar for dollar up to 6%.
• Employer paid life insurance – equal to 1x salary
• Employee may elect supplemental life insurance with low cost premiums up to 3x salary
• Adoption assistance
• LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
• Tuition reimbursement
• Student loan forgiveness

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees