Job Description
Managing RAC denials processes ensures accurate billing and compliance in healthcare settings, directly impacting hospital revenue by addressing overpayments from government audits. Specialists support RAC Managers and teams in analyzing denial claims using medical billing codes, helping to prevent financial losses for the system. This work involves reviewing electronic records and submitting appeals to maintain clean claims histories in a CMS-regulated environment.
CarolinaEast Health System serves coastal regions with a 350-bed hospital and outpatient services across four counties. Employing over 3,200 professionals, the organization delivers comprehensive care including emergency services and specialty clinics. Recognized as a Cardiovascular Center of Excellence, it fosters a community-centered culture with high-quality patient outcomes.
Specialists review RAC-related documentation, track denial trends using billing software, and coordinate with compliance teams. They utilize Excel for data analysis, HCPCS and DRGs for claim reviews, and Microsoft Word for reports. Interactions include collaborating with coders, physicians, and management staff. One constraint is navigating strict audit timelines while meeting productivity targets under variable claim volumes.
The role requires federal clearances and follows facility policies in North Carolina locations. Full-time employment in healthcare environments offers competitive packages with eligibility for part-time services. Benefits include a robust package for full-time employees, with health insurance starting day one. No specific compensation range provided, but professional development focuses on medical terminology training and auditing skills.
Responsibilities
- Support RAC Manager and RAC Staff in RAC process
- Manage RAC denials management
- Provide outstanding customer service upholding CarolinaEast's standards
Requirements
- High school diploma required, associate's degree preferred
- Experience in RAC, billing, coding, denials/appeals process preferred
- Knowledge of HCPCS codes, APC coding and DRGs preferred
- Three years working in a healthcare or hospital setting
- Working knowledge of basic medical terminology
- Computer skills including Microsoft Word, Excel or other word processing software