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Temporary Medicare Rac Audit Jobs in Virginia (NOW HIRING)

Elevance Health

Med Mgmt Nurse (contract)

Richmond, VA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

May complete quality audits and assist management with developing associated corrective action ... Medicare, Medicaid, MCG, NCD, LCD, LCA. Job Type: Possible Temp To Hire only Additional Details:

Elevance Health

Med Mgmt Nurse (contract)

Richmond, VA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

May complete quality audits and assist management with developing associated corrective action ... Medicare, Medicaid, MCG, NCD, LCD, LCA. Job Type: Possible Temp To Hire only Additional Details:

All JobsMedicare Rac Audit JobsTemporary Medicare Rac Audit JobsTemporary Medicare Rac Audit Jobs in Virginia

Temporary Medicare Rac Audit information

What is a temporary Medicare RAC audit?

Temporary Medicare RAC (Recovery Audit Contractor) Auditors are professionals hired on a short-term basis to review Medicare claims and identify instances of overpayments, underpayments, and billing errors. They analyze medical records and billing data to ensure compliance with Medicare regulations. These auditors help recover funds for the Medicare program and may work for government agencies or private firms contracted by the Centers for Medicare & Medicaid Services (CMS). Their work is crucial for reducing improper payments and improving the integrity of the Medicare system.

What does a temporary Medicare RAC audit professional do?

In a Temporary Medicare RAC (Recovery Audit Contractor) Audit role, your primary responsibilities include reviewing medical records, identifying improper Medicare payments, and preparing reports on audit findings. One common challenge is staying current with frequently updated Medicare regulations and ensuring compliance throughout the audit process. The role often involves working both independently and collaboratively with billing, coding, and compliance teams to resolve discrepancies and clarify documentation. Success in this position requires strong analytical skills and meticulous attention to detail, as well as effective communication with healthcare providers to explain audit outcomes and recommendations.

What skills and qualifications are needed for a temporary Medicare RAC audit professional?

To thrive as a Temporary Medicare RAC Audit professional, you need a solid background in healthcare compliance, medical coding, and a strong understanding of Medicare regulations, often supported by credentials like RHIA, RHIT, or CPC. Familiarity with audit management software, electronic health records (EHRs), and Medicare claims processing systems is typically required. Analytical thinking, attention to detail, and effective written communication are essential soft skills for reviewing records and reporting findings. These competencies ensure accurate claim evaluations, regulatory compliance, and effective collaboration with healthcare organizations during audit processes.

What is the difference between Temporary Medicare Rac Audit vs Medicare Billing Specialist?

AspectTemporary Medicare Rac AuditMedicare Billing Specialist
CredentialsKnowledge of RAC processes, compliance standardsMedical billing certifications, coding knowledge
Work EnvironmentAuditing firms, healthcare compliance departmentsHospitals, clinics, billing companies
Industry UsageFocuses on audit and compliance reviewsHandles billing, coding, and claims processing

While both roles involve healthcare finance, a Temporary Medicare RAC Audit focuses on reviewing and ensuring compliance with Medicare audit standards, whereas a Medicare Billing Specialist manages billing and coding processes to submit claims. The audit role emphasizes compliance and audit procedures, while the billing specialist concentrates on accurate claim submission and reimbursement.

What are popular job titles related to Temporary Medicare Rac Audit jobs in Virginia?

For Temporary Medicare Rac Audit jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Temporary Medicare Rac Audit jobs in Virginia look for?

The top searched job categories for Temporary Medicare Rac Audit jobs in Virginia are:

What cities in Virginia are hiring for Temporary Medicare Rac Audit jobs?

Cities in Virginia with the most Temporary Medicare Rac Audit job openings:

Temporary Medicare Rac Audit jobs near you

Nurse Auditor Revenue Integrity Specialist

Chesapeake Regional Healthcare

Chesapeake, VA • On-site

Full-time

Re-posted 28 days ago

Chesapeake Regional Healthcare rating

6.9

Company rating: 6.9 out of 10

Based on 22 frontline employees who took The Breakroom Quiz

Job description

Essential Duties and Responsibilities
These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.
  • Coordinate, supervise, and respond to third-party patient bill audits. Perform patient-requested audits in a timely manner. Perform random quality audits as schedule permits.
  • Assist Patient Account personnel with patient questions about itemized charges.
  • Maintain reporting systems for audit activities and identify patterns and trends in results.
  • Act as a resource for all hospital departments regarding charging questions and issues.
  • Routinely review inpatient and outpatient records for appropriate coding and charging.
  • Provide educational sessions for revenue-producing departments regarding appropriate charging processes and procedures.
  • Work cooperatively with the Patient Accounting staff and other healthcare professionals in obtaining correct HCPCS codes and modifiers.
  • Assist the Health Information Department with RAC requests, coding reviews, and denials.
  • Ensure accuracy and integrity of charge data prior to billing interface and claims submission.
  • Utilize a computerized encoding system to facilitate accurate coding and sequence diagnoses and procedures by following ICD-10-CM, Uniform Hospital Data Set, Medicare, Medicaid, and other fiscal intermediary guidelines.
  • Report trends and improvements to the Director of Patient Accounts regarding assigned HCPCS codes and modifiers.
  • Receive, review, verify, and process requests for chart audits of inpatient hospitalizations, diagnostic testing, outpatient procedures and services, home health care services, durable medical equipment, rehabilitative therapies, and pharmacy reviews from Finance and/or Claims departments.
  • Prepare written reports for Finance and Claims departments, including explanations for recovery of monies and appropriate regulatory agencies.
  • Educate Provider Services, Claims, Recovery, Finance, and other department staff on audit outcomes and assist Provider Services with educational efforts.
  • Provide feedback and process improvement recommendations to appropriate hospital departments and committees based on analysis and trending of hospital or provider audits.
  • Provide written explanations to patients questioning their bills. Must be able to communicate effectively, both verbally and in writing, with clinical and non-clinical staff and individuals.
  • Be familiar with coding diagnostic and procedural information from the medical record using ICD-10-CM and CPT-4/HCPCS classification systems. Utilize a computerized encoding system to facilitate accurate coding. Sequence diagnoses and procedures by following ICD-10-CM, Uniform Hospital Data Set, Medicare, Medicaid, and other fiscal intermediary guidelines.
  • Consistently maintain established productivity requirements and achieve a 96% or greater accuracy rate.
  • Attend hospital-wide orientation, in-services, educational meetings, and other meetings as required.
  • Attend continuing education functions as necessary to maintain credentials, regardless of whether educational programs are supported by the department budget.
  • Exhibit excellent customer relations with patients, visitors, physicians, and co-workers.
  • Show courtesy, compassion, honesty, and respect for others in adherence to the Hospital's mission, philosophy, and policies for promoting a positive work and customer environment.
  • Adhere to CRMC's confidentiality policy for all information related to patients, families and friends, hospital employees, physicians, and clients.
  • Maintain effective interdepartmental communication.
  • Attend required hospital-wide orientations, meetings, and in-services.
  • Demonstrate a commitment to flexible work scheduling when necessary.

Education and Experience
Minimum Required Education: Graduate of an approved school of professional nursing.
Preferred Education: Bachelor of Science in Nursing (BSN) preferred.
Experience: Senior-level coding experience with at least five years of recent coding experience in an acute hospital setting is required, with coding ability demonstrated through a skills assessment; or five years of experience as an intensive care unit nurse, emergency department nurse, or documentation specialist nurse auditor.
Experience with health information systems and computer technology is required.
Must possess the ability to communicate effectively, both verbally and in writing, and work independently with strong attention to detail and accuracy.
Certificates, Licenses, Registrations
  • Current Virginia Registered Nurse (RN) License.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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