Clinical RAC Auditor
Sentara(4 months ago)
About this role
A Recovery Audit Contractor (RAC) Auditor performs clinical-focused auditing and review of claims to determine medical necessity and support claim adjudication in accordance with contract and payer rules. The role sits within the healthcare revenue-cycle environment and requires clinical licensure and coding credentials. It supports compliance with government payer regulations and managed care arrangements.
Required Skills
- Medical Necessity
- Medicare Guidelines
- Payer Guidelines
- Managed Care
- Clinical Review
- Internal Auditing
- Coder Education
- Medical Records
- Charge Master
- Acute Care Coding
+3 more
Qualifications
- RN Bachelor Degree
- RN Associate Degree
- RN Diploma
- Registered Nurse License
- CPC
- CCS
About Sentara
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