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UNC Health · 2 weeks ago

Recovery Audit Contractor (RAC) Coordinator (RN)

United States

Full-time, Contract

Remote

Entry, Mid Level

2+ years exp

UNC Health is an inclusive organization with a mission to improve the health and well-being of the communities they serve. The Recovery Audit Contractor (RAC) Coordinator (RN) is responsible for managing Care Management Denial and RAC requests, ensuring timely follow-ups, and coordinating the appeal process.

Addiction TreatmentHealth CareHealth DiagnosticsHospitalNon ProfitWellness

Responsibilities

Coordinates the Denial and RAC process, including requests, follow-ups, tracking of approvals and denials, and completing appeals. Oversees/maintains the denial and RAC request/response data bases; ensures the timeliness of the response/submission of records and outcomes. Works with EHR to file appeals and coordinate the follow up with EHR. Coordinates all activities associated with denial and RAC requests, appeals, etc. Handles all the denial and RAC requests from the time the letter is received until all charts are finalized either as approved or denial. Ensures proper implementation of RAC process

Communicate effectively with administration and management, members of the medical staff, patient care services and ancillary departments, as well as all affected external entities, involved in the denial/RAC process. Serves as the liaison between the organization and Care Management regarding Denial/RAC process, including all related concerns and actions. Documentation - Documents activities, events, and information per standards in established software systems in a timely, accurate, and complete manner

Develops and maintains policies and procedures for the Denial/RAC process; evaluates the process to ensure effectiveness of current policies and procedures and makes recommendations to further develop the process as needed. Provides statistics and reports to administration, UR Committee, and any other committee as requested by management. Provides education to care managers, coders and physicians regarding CMS updates, changes, etc

Qualification

Registered Nurse LicenseAcute Care ExperienceBasic Life Support (BLS)Certified Case Manager (CCM)Care Management ExperienceVerbal CommunicationWritten Communication

Required

Must be licensed to practice as a Registered Nurse in the state of North Carolina or one of compact states

Two (2) years of experience working as a Registered Nursing in an acute care inpatient setting, including expertise and extensive knowledge of complex disease processes

Excellent verbal and written communication

Basic Life Support (BLS) certification