This position is the main contact for RAC and acts as the hospital liaison for all RAC related concerns/actions. Responsible for interacting on a professional basis with members of the medical staff, administration, management, patient care services, ancillary departments, to help determine which denials to appeal Also responsible for interacting on a professional basis with RACX contacts and contracted appeal resources, e.g., Executive Health Resources (EHR). Functions as case manager when as needed/scheduled.
Description of Job Conducts oversight of all RAC functions Develop internal training programs for medical staff, nursing staff and other disciplines as appropriate. Track status of all RAC activity using RAC Manager Open communication between RAC coordinator and: director, CNO, CFO, HIM, business office, case management, physician advisor/E H R, RACs/CMS/First Coast Coordinate all activities associated with RAC requests, appeals, etc. Manage and track hand-offs between departments Manage and track RAC timelines for requests and RAC responses Communicate with all affected external entities involved in the RAC process Analyze audit and RAC findings Follow all RAQC activity to closure Coordinate the RAC committee and provide appropriate reports
Current RN licensure in the state of Florida Bachelors degree preferred CDIS, CCM, ACM or CPUR preferred
Additional requirements per Department Policy
Special Qualifications: Excellent oral and written communication skills Excellent interpersonal skills with groups and one on one Knowledge of medical terminology, levels of care, treatment modalities Knowledge of case management principles/practice and Interqual criteria Knowledge of state/federal regulations and accrediting agency standards Ability to enter data and manage data base with 100% accuracy Ability to work within strict deadlines
- At least 2 yrs of acute care experience, and 1 yr Case Management experience. • Working knowledge of compliance regulations