Auditor, RAC - Clinical

Optima Health Virginia Beach , VA 23452

Posted 10 months ago

Job Description:

The Recovery Audit Contractor (RAC) Auditor is responsible for determining the clinical necessity that supports the claim in accordance with the respective contract while also coordinating the disposition of the denied claim with the appropriate personnel. Must demonstrate an understanding of Medicare and other payer guidelines related to billing and charging of observation services, other separately chargeable services, and other lines of service.

Must demonstrate knowledge of managed care contracting arrangements as well as notification and clinical review requirements. Must also be knowledgeable of regulatory and compliance requirements for government payers regarding clinical reviews and medical necessity. Possess the ability to perform a number of functions including those of internal auditing, coder education, liaison with external auditors for corporate audits.

Required Education

RN-Associate's Degree OR

RN-Bachelor's Level Degree OR

RN-Diploma (Non-degree)



icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Clinical Assessor

Civitas Health Services

Posted 2 days ago

VIEW JOBS 2/27/2020 12:00:00 AM 2020-05-27T00:00 Overview Civitas Health Services, Inc. is seeking to hire a highly skilled and motivated Clinical Assessor who's looking to excel in a professional clinical environment, where your leadership skills and creativity can be the focus of your practice. Civitas Health Services is a progressive, innovative and growing company, that strives to provide the highest quality of person-centered therapeutic services and medication assisted treatment services to children, adolescents, and adults throughout the State of Virginia, and we are looking for the best clinically trained leaders and professionals, to continue to expand our vision. About Civitas Health Services, Inc. Civitas Health Services, Inc is a provider of comprehensive Applied Behavioral Analysis, Substance Abuse, Mental and Behavioral health services in the Greater Richmond and Hampton Roads Area. Our team of professionals are invaluable to our organization. They embody our commitment to excellence and service to the community, while providing quality care and customer service. We match their commitment by providing our team with competitive compensation and professional growth opportunities. Essential Duties and Responsibilities * Responsible for the assessment and reassessment of referred individuals and current individuals * Responsible for the development and completing clinical assessments * Responsible for the developing and submitting authorizations and reauthorizations for individuals receiving services * Participates in regular collaborative consultation with the Clinical Director, Clinical Supervisor and Program Managers as needed with regards to any individual concerncs that arise during the assessment process * Responsible for the maintenance of all applicable State, Federal and Local standards with regards to performance of the assessment and reassessment process * Communicates in an articulate and professional manner with parents, individuals; responds to grievances/complaints * Connect the family to wrap around services as needed to include but not limited to; health services, recreational activities, child care services, financial resources, employment resources, transportation resources, support groups, and other therapeutic services * Attends meeting to discuss assessment results, progress and recommendations Qualifications * Master's Degree in social work, psychology, or a related human service field from an accredited college or university * Must be LMHP with the Virginia Department of Health Professions * Must have 1+ years of experience providing therapeutic services to individuals with a mental health diagnosis * Must have 2+ years of ABA scope of practice Civitas Health Services Virginia Beach VA

Auditor, RAC - Clinical

Optima Health