Job Description

Warbird Consulting Partners actively seeks qualified candidates for an exciting position as Interim RAC Audit Specialist for a large integrated healthcare system in Southwest. Reporting to the Senior Director of Revenue Integrity, the interim RAC Audit Specialist coordinates all activities associated with the chart audits and status tracking for Recovery Audit Contractor (RAC) and government audit related denial issues. 

Warbird engages talent and expertise across all of our practice areas and assembles experienced teams to solve a wide range of complex, pressing accounting and finance issues. Our consultants typically have 15-25 years plus of industry experience and know firsthand the daily challenges our clients encounter. We fit our consultants’ skills to the needs of our clients to ensure a successful experience for all. If you’re ready to take on the challenge, then let us help you advance your career in consulting.

Duration: ~ 6 -9 months

Location: Remote

Responsibilities

• Identifies risks and trends, facilitating cross-departmental tactical actions.
• Coordinates the RAC denial and appeal process and maintains the database tracking system.
• Assists with medical necessity, coding and billing reviews as they relate to the denial of issue.
• Review medical records and other documentation for accuracy and professional appearance, and send RAC appeal package accordingly.
• Identify problem claims and appeals and escalate as appropriate
• Update the appropriate systems to identify actions taken on the accounts
• Perform daily appeal audit follow- up, monitoring RAC audit trends and issues and updated financial transactions.
• Review medical records and other documentation for accuracy and professional appearance, and send RAC appeal package accordingly
• Monitor RAC takebacks and appeal status by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons.
• Identify problem claims and trends and escalate as appropriate
• Work with RAC Agencies to secure payment on account balances outstanding
• Other duties as assigned

Job Requirements

QUALIFICATIONS

• Bachelor’s degree in healthcare, business, Health Information Management, nursing or applicable field preferred.
• RHIA/RHIT/CCS certification
• Minimum of 7 years of experience with RAC and government audits, denial or coding, billing, documentation and auditing in a hospital, outpatient clinical setting or physician’s office required.
• Previous experience and familiarity with CMS regulations, billing compliance; Medicare, Medicaid and other third-party payer reimbursement methodologies.
• Working knowledge of State and Federal Regulations related to documentation, coding and billing.

E-Verify - Warbird participates in the Electronic Employment Eligibility Verification Program. Warbird is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, religion, national origin, age, disability, veteran status, genetic data, religion or other legally protected status. INDS