Patient Accounting RAC Analyst

Northwestern Medicine - Warrenville, IL

Full-time

Warrenville, IL

Hospitals

About the position

The Patient Accounting, Recovery Audit Contractor (RAC) Analyst plays a crucial role in supporting the Medicare and Medicaid Recovery Audit Contractor programs at Northwestern Memorial. This position involves generating financial information for RAC claims, documenting RAC activities, and ensuring compliance with relevant policies and regulations. The RAC Analyst will work closely with various departments to monitor RAC updates, assist in compliance education, and implement operational changes to enhance service delivery and efficiency.

Responsibilities

• Monitor RAC program updates related to Patient Accounting and Patient Financial Service functions.
• Assist in coordinating and performing various RAC-related activities to meet documentation requests and deadlines.
• Generate financial and relevant information for RAC claims under review and facilitate data gathering for management.
• Input RAC notation, DRG, claim, and reimbursement information into appropriate systems.
• Collect, organize, and interpret RAC data to identify and prioritize areas of risk.
• Work with various departments to implement operational changes for compliance with RAC requirements.
• Ensure timely and accurate Compliance Education and Training programs within Patient Financial Services.
• Adjust claim information in systems to reflect accurate DRG and level of care for RAC claims.
• Document issues and resolutions comprehensively to provide an audit trail.
• Evaluate procedures and suggest improvements to enhance customer service and operational efficiency.

Requirements

• Bachelor's Degree or four additional years of relevant experience.
• 4-6 years of hospital healthcare experience with a focus on government programs.
• Knowledge of Recovery Audit Contractor Program.
• Knowledge of ICD 9/10, CPT, HCPCS & MS-DRG coding, healthcare billing, and 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 and effective listening ability.
• Excellent written and oral communication skills.

Nice-to-haves

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