JOB SUMMARY:    The Audit RAC Coordinator serves as the internal primary contact and representative for the Patient Accounts department regarding any communication received regarding, any type of audit request. Is knowledgeable in the specific functions of the position, and serves as a resource for co-workers. The Audit RAC Coordinator is responsible for maintaining integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, MEDICAID), Payor DRG reviews and changes and other external audit requests as they are created / received. Position is responsible for logging and tracking all incoming requests and updating electronic log when requests are responded to and actions as they occur.

EDUCATION, EXPERIENCE, TRAINING

1. Acute hospital business office experience.
2. Prior Claim Denial Management experience is desirable.
3. Knowledge of care delivery documentation systems and related medical record documents.
4. Knowledge of Paragon and related billing systems.
5. Excellent written and verbal communication skills. Excellent critical thinking skills.
6. Excellent interpersonal skills to build effective partnering relationships with physicians, case management staff and hospital management staff.
7. Working knowledge of inpatient admission criteria.
8. Ability to work independently in a time-oriented environment.
9. Computer literacy and familiarity with the operation of basic office equipment.
10. Assertive personality traits to facilitate ongoing inter-department communication.
11. Working knowledge of Medicare reimbursement system and coding structures preferred.

DUTIES AND RESPONSIBILITIES 

1. Coordinate all RAC/ Audit correspondence. Develop training and education for issues identified by such audits. Conducts oversight of all Audit request and resolution functions and follow all activity to closure.
2. Works effectively with clinical documentation staff to finalize all necessary reviews and retro reviews to decrease denials. Manage and track hand-offs between departments.
3. Performs daily audits of work performed by outside coding vendors.
4. Reports weekly to HIM Manager, Revenue Cycle Manager, Quality Director findings of audits.
5. Maintains data base for tracking denials, reason, appeals, and outcome of appeals. Track status of all audit & RAC activity using automated tracking system.
6. Collects, analyzes, aggregates, and presents data accurately.
7. Reviews medical records and other documentation to prepare Audit / RAC appeals packages. Works with external vendor to escalate appeals as needed.
8. Communicate and coordinate with various individuals/distributions and assist with the management of the day to day activities related to Government Audit Reviews. Open communication between HIM Director and Administration/ CFO, HIM team including Coding/ ROI, and Business Office/ Financial Services, Case Management/ Physician Advisor for clinical Review, RACs/ CMS.
9. Collect/analyze, report status, metrics and trends of activity by different reviews from tool. Distribute reports on a routine basis to specific distribution group. Coordinate the RAC Committee with reports to Corporate compliance.
10. All Audits are to be kept in an organized retrievable way and also electronically scanned and filed.
11. Assist with coordination of Government Review Audits (RAC) Committee activities and materials for committee meetings, including agenda, dashboards, analyses, reports, etc.
12. Responsible for the communication of all new policy's, memorandums and processes from department and/or governmental payers for all review audits.
13. Maintain integrity of Audit / RAC database and assist in financial and clinical reporting of activity. Invoice submitted record requests, if applicable.
14. Responsible for review/analyze of audits that are received and the validity of findings of various audit contractors.
15. In the event findings are incorrect, position responsible for communicating with audit contractors for correction and submitting evidence.
16. Develop Internal Training Programs. Other functions outside of Audit / RAC function such as clinical review, clerical/ administrative support for RAC tracking system data entry, Release of Information (ROI) process/ function. Perform other duties as assigned.