RACS/Denial Coordinator Job in Meadowbrook 19046, Pennsylvania US
Position Summary: The RAC/Denial Coordinator works under the direct supervision of the Compliance Officer and the designated Health Care Delivery Division (HCDD) Vice President (dual reporting responsibility) and will serve as the central point person for all government claim recovery activities and retrospective denials from third party payers. This position is accountable for timely and accurate release of governmental and recovery audit contractor requested patient medical information, tracking and follow-up of requests for claims information, and timely coordination of appeals and associated deadlines. Other duties include: performing clinical chart audits, interfacing with the concurrent review process for third party payors, analyzing denials, and preparing trend and analysis reports as requested. In addition, education is a key responsibility of the position. This includes education of the medical staff, nursing staff and other interdisciplinary team members with regard to application of severity of illness and intensity of service criteria, and other related clinical documentation requirements necessary to substantiate medical care as rendered in the acute care setting. This coordinator is also accountable to collaborate with the HCDD Manager of the Care Management Department and its associated Medical Director.
Recruitment Requirements:
Candidates must be a Registered Nurse (RN) An Associate's degree is required; Bachelor's degree preferred.
Two years of clinical auditing experience and insurance recovery experience is preferred.
Previous experience working with Medicare’s Local National Coverage Determinations preferred
Must have exceptional organizational and communication skills, and must be proficient with spreadsheet and database applications.
Excellent organizational skills, good computer skills, good written and verbal communication skills, the ability to work independently, and the ability to provide outstanding customer service.
An understanding of the appeals process and the ability to coordinate the appeals process will be needed.
Knowledge of existing RAC tracking software or ability to proficiently master the software.