Patient Accounting RAC Analyst

The salary range for this position is $25.72 - $37.30 (Hourly Rate)

Placement within the salary range is dependent on several factors such as relevant work experience and internal equity. For positions represented by a labor union, placement within the salary range is guided by the rules outlined in the collective bargaining agreement.

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section located at jobs.nm.org/benefits to learn more.

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From discovery to delivery, come help us shape the future of medicine.

Description

The Patient Accounting, Recovery Audit Contractor (RAC) Analyst reflects the mission, vision, and values of Northwestern Memorial, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Under the direction of the Patient Accounting (“PA”) Medicare & Medicaid Manager, the RAC Analyst will serve as the primary department resource in support of all activities related to the Medicare and Medicaid Recovery Audit Contractor (“RAC”) programs. This includes generating financial and other relevant information for RAC claims under review, documenting RAC activity in appropriate systems, and adjusting DRG/claim information as necessary related to RAC activities.

Responsibilities:

• Monitor RAC program updates, as they relate to Patient Accounting and Patient Financial Service functions (i.e., Admitting & Registration and Patient Accounting).  In conjunction with the Office of Corporate Compliance & Integrity and other areas, assist in the coordination of and perform various RAC related activities that are the responsibility of the PA department to ensure RAC documentation requests and deadlines are met.

Essential:

• Monitors RAC related publications and resources to assist Patient Accounting management with understanding RAC related issues, as it relates to PA functions.
• Monitors and communicates potential RAC issues impacting Patient Accounting and compiles action/activity reports in support of corrective action/process improvement.
• Generates financial and other relevant information for RAC claims under review and researches and facilitates data gathering for Manager of Patient Accounting, Director of Patient Accounting and/or the Office of Corporate Compliance & Integrity providing data and/or various reports.
• Inputs RAC notation, DRG, claim, and reimbursement information related to RAC claims under review into appropriate systems (i.e., Primes, RACTracker, etc.)  Collects, organizes, and interprets RAC data for identification and prioritization of areas of risk.
• Works with Office of Corporate Compliance & Integrity, Billing and other hospital areas to implement operational changes to ensure NM compliance with RAC requirements as they relate to PA functions.
• Works with the NM Academy and PFS Management to ensure timely, accurate, and regular Compliance Education and Training programs within PFS.
• Adjusts claim information in applicable systems to appropriately reflect accurate DRG, level of care, etc. for RAC claims under review.
• Assess/evaluate new RAC information and help determine required systems or operational actions.
• Document completely, issues and resolutions, on a case by case basis, providing a comprehensive audit trail.
• Consistently practice “Patients First” philosophy and adhere to high standard of customer service consistently for internal and external customers.
• Evaluate procedures and suggest improvements and changes to enhance customer service and operational efficiency.
• Performs other related duties as assigned by manager.

 

Qualifications

Required:

• Bachelors Degree or four additional years of relevant experience
• 4-6 years of hospital healthcare experience equivalent with specific government programs focus
• Knowledge of Recovery Audit Contractor Program
• Knowledge of ICD 9/10, CPT, HCPCS & MS-DRG coding, healthcare billing, medical records,
• Ability to review/analyze billing documentation including UB 04 bill form, CMS 1500 form, EOBs & remittance advices
• Demonstrated ability to work with various levels within the organization regarding confidential information and maintain sensitive data.
• Expert user experience with MS Excel
• Ability to run system queries & reports
• Strong interpersonal skills, demonstrate ability to listen effectively.
• Excellent written and oral communication skills.

Preferred:

• MS Word & PowerPoint ability
• Coding credential (CCS, CPC-H, RHIT, RHIA)
• Project Management

Equal Opportunity

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

If we offer you a job, we will perform a background check that includes a review of any criminal convictions. A conviction does not disqualify you from employment at Northwestern Medicine. We consider this on a case-by-case basis and follow all state and federal guidelines.

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.