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Job Title:

Cost Center:

Job Description:

Position Summary:

The RAC Coordinator is responsible for developing, interpreting, and implementing operational requirements for the CMS Recovery Audit Contractor program and has accountability for daily management, monitoring, and direction of RAC Activities. This position provides financial data and analysis for internal and external reporting, ensures GPH is prepared for RAC audits, responds to audit requests, challenges questionable determinations, and files timely appeals.

Minimum qualifications:

◾ Education Bachelor's degree or equivalent combination of education and work experience. Extensive knowledge of CMS rules and regulations. Knowledge of state and federal laws related to healthcare billing requirements. A minimum of three years of hospital coding, billing, or revenue integrity experience. ◾ Credentials A Certified Professional Coder with a Registered Health Information Technician (RHIT), or a Certified Coding Specialist (CCS), and/or Registered Health Information Administrator (RHIA) preferred. Clinical background preferred.

Essential Functions

1. Central point person for all government claim recovery activities.

2. Coordinates, initiates, monitors, and responds to all audit requests/demands.

3. Initiates and monitors the appeal processes in a timely manner.

4. Performs research, gathers financial data, and conducts focused audits on Medicare and Medicaid billing to analyze, summarize, prepare reports, and make recommendations.

5. Coordinates with facility subject matter experts when necessary.

6.Uses data or maintains database to track information including but not limited to trends regarding Medicare and Medicaid billing practice both within and outside of the hospital.

7. Manages internal and external billing audit communications for all audit-related correspondence.

8. Continuously evaluates and improves processes in preparation for audit requests and in response to audit findings. Assists interdisciplinary teams in identifying and prioritizing areas of process improvement and develop/implement processes and tools to mitigate risk

Join us. Join great. Join the dynamic team at Great Plains Health and be a part of something truly exceptional. At Great Plains Health, we embody a culture defined by authenticity, integrity, and a genuine commitment to listening to both our patients and each other.

As a member of our team, you'll experience a supportive environment where collaboration is key, and every voice is valued. We work together seamlessly, leveraging our collective strengths to provide the highest quality care to our community.

Passion drives us forward, propelling us to constantly strive for excellence in everything we do. If you're seeking a rewarding career in healthcare surrounded by like-minded individuals who share your dedication and enthusiasm, Great Plains Health is the place for you. Come join us and be part of a team that's making a real difference every day.