- New York State Civil Service (Albany, NY)
- …Albany State NY Zip Code 12204 Duties Description Duties for this role:*Collaborate closely with the Recovery Audit Contractor ( RAC ) to support audit ... the MDW and utilizing Draft Audit Report (DAR) and Final Audit Report (FAR) procedures.*Verify and validate all contractor -submitted data for accuracy… more
- Guthrie (Sayre, PA)
- Summary The Denial, Appeal, and Audit Manager is responsible for the oversight and management of all payer denials, appeals, and audit processes within the ... resolution of claim denials, effective appeal strategies, and proactive audit response. The manager leads a team of specialists,... Oversight + Manage payer and third-party audits (eg, RAC , MAC, UPIC, commercial payers) + Coordinate timely record… more
- Beth Israel Lahey Health (Newburyport, MA)
- …direction of the Director of Health Information Management, the Health Information Management Audit Specialist handles various audit requests for the release of ... all the logging and tracking of requests and the audit process from initiation through mailing, in collaboration with...request for specificity in the documentation requested (eg, MAC, RAC , Payor Audits, Compliance Audits) and verifies that the… more
- AdventHealth (Hinsdale, IL)
- …from regulatory agencies including, but not limited to, Additional Development Requests (ADRs), Recovery Audit Contractor ( RAC ) requests, Quality ... team:** + Coordinates all phases of record request processing, including ADRs, RAC requests, and Medicaid audits. + Develops and implements procedures and processes… more
- HCA Healthcare (Plano, TX)
- …criteria is met in compliance with departmental policies and procedures + Review Medicare Recovery Audit Contractor ( RAC ) recoupment requests and process ... or appeal as appropriate + Compose technical denial arguments for reconsideration, including both written and telephonically + Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument +… more
- Hospice of Michigan (Southfield, MI)
- …complete responses to Additional Development Requests (ADRs), Comprehensive Error Rate Testing (CERT), Recovery Audit Contractor ( RAC ) etc., requests and ... participates in appeal processes. + Participates in the development and annual revision of Quality Assessment and Improvement Plans and Program Evaluation. + Participates in analyzing, developing, coordinating and implementing plans of correction for noted… more
- HonorHealth (AZ)
- …improvement efforts + Supports compliance related to consistency of technical and professional: Recovery Audit Contractor ( RAC ) reviews. + Performs ... other duties as assigned Education + MD or DO Board Certified Physician with a special interest in Utilization Management & Quality Improvement in - Required + Graduates of an accredited medical school - Required Experience + 5 years of recent experience in… more
- Celestica (Maple Grove, MN)
- …and partners, and ensuring compliance with regulatory requirements (FDA, ISO, ASQ, RAC ). The position is virtual, offering competitive compensation and career growth ... customer surveys, operational reviews, and system applications. * Cultivate an " audit -ready" culture and direct the Global Regulatory Compliance Audit … more
- Baylor Scott & White Health (Phoenix, AZ)
- …focused on appealing hospital and professional clinical and coding denials, as well as Recovery Audit Contractors ( RAC ) denials. This role will be ... payer denial codes, appeal strategies and regulatory frameworks. + Familiarity with RAC audit processes preferred + Experience collaborating across multiple… more
- Community Health Systems (Franklin, TN)
- …The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non- RAC accounts, reviewing patient records for accuracy in ICD-10-CM/PCS ... to payers with a strong attention to detail. Additionally, the auditor provides audit feedback to relevant parties, including coders and coding managers, to improve… more