RAC Auditor - RN

Under the supervision of the RAC Manager, the RAC Auditor provides effective management of the RAC, QIO, and MAC, response process, including guidance, support, and oversight for AMG practices. This position manages the audit and/or appeal process, coordinating with internal experts while working closely with outside representatives involved with RAC audits and appeals. The RAC auditor may work with legal representatives, consulting appeal managers, Palmetto GBA, MAC’s, QIO’s, CMS representatives and other involved parties as required. The RAC Auditor works in Compliance and closely with Case Management, Health Information Management, Business Office, Revenue Cycle, and all affected AMG practices under audit or at risk for audit. The RAC Auditor evaluates, tracks, and measures effectiveness of responses to RAC audits, and maintains timing of responses in accordance with CMS regulations. The RAC Auditor will manage, monitor, support, and report on the consistency and adequacy of AMG’s response to the RAC recovery requests.

Education Required

• Current and valid Registered nurse license in the Commonwealth of Virginia or from a state that is part of a Compact agreement with Virginia.
• BSN required.
  
  

Experience Required

• Minimum of five years of clinical education and training.
  
  

Experience Desired

• Coding experience preferred.
• Quality experience preferred.
• Billing, reimbursement and auditing knowledge or training, including familiarity with CMS Claims Processing Manuals for all medical disciplines and services preferred.
• Familiarity with Recovery Audit Contractor, Medicare Audit Contractor, Zone Program Integrity Contractor, Medicare CERT Audits, and other payer audit mechanisms and processes preferred.
  
  

Skill Requirements

• Excellent verbal and written communication skills.
• Ability to educate team members from all professions and all backgrounds, present complex topics and effectuate process changes.
• Excellent research and organizational skills.
• Auditing skills, including review of medical records for documentation accuracy to support medical necessity as defined by CMS.
• Report development and data analytic skills.
• Process and quality improvement skills.
• MS Excel, MS PowerPoint, MS Word and other software management.
  
  

Skills Desired

• Quality Improvement, Process Improvement, or similar skills and training preferred.
• Familiarity with Athena and Meditech patient management systems preferred.
• Presentation and education skills for providers and staff at all levels throughout the enterprise.
• Ability to review, understand, and interpret complex CMS regulations.
• Ability to monitor, manage, and respond to time sensitive government agency requests and recoupment demands.
• Ability to manage projects with multi-million-dollar scope.
• Ability to assist providers and argue treatment details at MAC, RAC, QIO, Administrative Law Judge, and Federal Appeals levels.
  
  

Some Benefits Of Working At Augusta Health Include

• Generous paid time off to promote work life balance.
• Competitive Pay.
• Retirement Plan.
• Medical, Dental, and Vision Benefits.
• Free onsite parking.
• Tuition reimbursement.
• Onsite childcare.
  
  

Company Information

Augusta Health is a mission-driven, independent, nonprofit, community health system located in Fishersville Virginia in Virginia’s scenic Shenandoah Valley. Augusta Health offers a full continuum of inpatient and outpatient services which includes Augusta Medical Center a 255 bed inpatient facility and Augusta Medical Group which is comprised of 40 practice locations and four urgent care locations.

Equal Opportunity

Augusta Health recruits, hires and promotes qualified candidates for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran or military discharge status, and family medical or genetic information.

About Augusta Health

Augusta Health opened in 1994 to continue a tradition of personalized care with small-town hospitality that began with predecessor hospitals in Staunton and Waynesboro. Today, our highly trained physicians and staff use state-of-the-art technology to provide top quality care with warmth and compassion. We offer many amenities so patients and families can be comfortable and close during difficult times Quick Stats for 2022 255 beds 225 active medical staff 2,450 employees 50 volunteers 74 hospice volunteers 59,573 emergency visits 10,324 admissions 892 babies delivered 549 new cancer patients 585,703 outpatient visits to Augusta Medical Group clinics 293,795 other Outpatient Registrations (this includes Home Health, Laboratory, Outpatient Surgery, Imaging, etc.) 61,166 Urgent Care Visits