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Sentara Health · 10 hours ago

Clinical RAC Auditor

Norfolk, VA

Full-time

Onsite

Mid, Senior Level

5+ years exp

Sentara Health is a healthcare organization that is committed to improving health every day. They are seeking a Clinical RAC Auditor who will be responsible for determining clinical necessity for claims and coordinating the resolution of denied claims. The auditor must have a strong understanding of Medicare guidelines and regulatory compliance in the healthcare sector.

Hospital & Health Care

Responsibilities

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

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

Demonstrate knowledge of managed care contracting arrangements as well as notification and clinical review requirements

Knowledgeable of regulatory and compliance requirements for government payers regarding clinical reviews and medical necessity

Ability to perform a number of functions including those of internal auditing, coder education, liaison with external auditors for corporate audits

Qualification

Registered Nurse licenseMedicare guidelines knowledgeAcute Care Coding experienceCPC certificationCCS certificationHealthcare Auditing experienceUnderstanding medical recordsManaged careRegulatory compliance knowledgePatient needs recognition

Required

Registered Nurse license required

CPC or CCS required within 6 months of hire

5 years Acute Care Coding experience required

RN Bachelor Level Degree

2 yr RN Associate Degree

RN Diploma

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

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 Charge Master

Preferred

Previous Healthcare Auditing experience

Benefits

Medical, Dental, Vision plans

Adoption, Fertility and Surrogacy Reimbursement up to $10,000

Paid Time Off and Sick Leave

Paid Parental & Family Caregiver Leave

Emergency Backup Care

Long-Term, Short-Term Disability, and Critical Illness plans

Life Insurance

401k/403B with Employer Match

Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education

Student Debt Pay Down – $10,000

Reimbursement for certifications and free access to complete CEUs and professional development

Pet Insurance

Legal Resources Plan

Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Company

Sentara Health

Glassdoor3.7

Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 135 years in pursuit of its mission - "we improve health every day." Sentara is one of the largest health systems in the U.S.

Founded in 1988

Hampton Roads, VA, US

10001+ employees