Coordinates all audit activities related to the Medicare Recovery Audit Contractor (RAC) Program, Medicare Administrative Contractor (MAC), Comprehensive Error Rate Testing (CERT) reviews, commercial payers, etc. Logs and tracks audit records requests, organizes, coordinates and tracks appeal processes at all levels. Ensures that audit findings are reviewed timely and appeals are completed and submitted within payer deadlines. Responsible for monitoring trends found in audit requests and denials... more details
Coordinates all audit activities related to the Medicare Recovery Audit Contractor (RAC) Program, Medicare Administrative Contractor (MAC), Comprehensive Error Rate Testing (CERT) reviews, commercial payers, etc. Logs and tracks audit records requests, organizes, coordinates and tracks appeal processes at all levels. Ensures that audit findings are reviewed timely and appeals are completed and submitted within payer deadlines. Responsible for monitoring trends found in audit requests and denials and providing education materials to team members for one-on-one education to medical center departments and their office staff.
- Organize and document all payer audits in a third party vendor tracking tool and update with changes and completions.
- Communicate and coordinate across departments to ensure audits receive the proper review, appeals and resolution.
- Coordinates with other departments (HIM, Care Management, Revenue Integrity, etc.) to obtain appeal responses and justification and compiles responses and submits in appropriate format and according to payer requirements.
- Reviews and evaluates hospital bill audits to determine appropriate course of action. Develops and writes appeal rationale and submits according to payer requirements.
- Responds timely to all payer audit requests and submits appeals within payer deadlines.
- Analyzes trends from audit requests and denials and provides to stakeholders for education and process improvement.
- Monitors RAC/MAC and private payer related resources and websites to identify changes in payer requirements and other relevant audit information and incorporates into existing audit processes.
- Develops reporting on audit activity for presentation to leadership at Revenue Cycle Operations meetings.
- In addition to the above job responsibilities, other duties may be assigned.
Position Compensation Range: $21.10 - $32.71 Hourly
MINIMUM REQUIREMENTS
Education: High School or Equivalent required. Bachelor's degree Preferred.
Experience: 3 years of Revenue Cycle Experience or Bachelor's degree and 1 year of Revenue Cycle experience. Licensure: None required.
PHYSICAL DEMANDS
Job requires sitting for prolonged periods, frequently traveling (no more than two miles). Proficient communicative, auditory and visual skills; Attention to detail and ability to write legibly; Ability to lift/push/pull < 20lbs. May be exposed to cold, heat, and outdoor climate.
The University of Virginia, including the UVA Health System which represents the UVA Medical Center, Schools of Medicine and Nursing, UVA Physician’s Group and the Claude Moore Health Sciences Library, are fundamentally committed to the diversity of our faculty and staff. We believe diversity is excellence expressing itself through every person's perspectives and lived experiences. We are equal opportunity and affirmative action employers. All qualified applicants will receive consideration 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 status, and family medical or genetic information.
