RAC (Recovery Audit Contractor) Spec ATL WFH - Parallon

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Company: HCA
Location: Norcross, GA
Date Posted: April 9, 2015
Source: HCA
Title: RAC (Recovery Audit Contractor) Spec ATL WFH - Parallon
Location: United States-Georgia-Norcross-Shared Services - Atlanta
Other Locations: null
DUTIES INCLUDE BUT ARE NOT LIMITED TO:

* 
Review medical records and other documentation and prepare 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 appeals and escalate as appropriate 
* 
Update the RAC Log and any other systems (Artiva, SSD Web Tools) to identify actions taken on the account 
* 
Work with RAC Agencies to secure payment on account balances outstanding for clinical reasons 
* 
Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement” 
* 
Other duties as assigned
KNOWLEDGE, SKILLS & ABILITIES

* 
Communication - communicate clearly and concisely, verbally and in writing 
* 
Customer orientation - establish and maintain long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations 
* 
Interpersonal skills - able to work effectively with other employees, patients and external parties 
* 
PC skills - demonstrates proficiency in Microsoft Office applications and others as required 
* 
Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems 
* 
Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately 
* 
Clinical skills - ability to read and interpret medical records 
* Knowledge of Medicare guidelines
EDUCATION

* 
Associate’s Degree preferred
EXPERIENCE

* 
At least 2 years of utilization review experience required 
* 
InterQual knowledge required 
* 
Case Manager experience preferred 
* 
Insurance utilization experience preferred 
* 
Hospital experience preferred 
* 
Relevant education may substitute experience requirement
CERTIFICATE/LICENSE- • LPN, RN, HIT, HIA certification preferred

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