Compliance RAC Auditor
US-IL-Peoria
External Apply Portal
Req #: 93332
Type: Full Time
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Overview: POSITION SUMMARY: The Compliance Recovery Audit Contractors (RAC) Auditor provides guidance, support and oversight to OSF Healthcare System (OSF) to ensure effective management of all government claim audits such as RAC, Medicare Administrative Contractor (MAC), Comprehensive Error Rate Testing (CERT) and Office of Inspector General (OIG). Responsibilities include: response/appeal process; tracking requests and progress throughout the audit process; evaluating data associated with RAC and other governmental audit activities; tracks and measures the effectiveness of OSF responses and assesses additional potential reimbursement risks due to current RAC and governmental audit activity. Assesses risk, plans, and performs proactive audits to promote compliance with government rules and regulations. Qualifications: REQUIRED QUALIFICATIONS: Education: Bachelors degree Licenses/Certifications: RN-Registered Nurse Experience: 5 years experience in nursing or professional medical coding, billing, compliance or audit in a healthcare setting Other skills/knowledge: Solid computer skills, including proficiency with Microsoft software.; Strong analytical and problem solving skills, with the ability to be detail oriented. PREFERRED QUALIFICATIONS: Experience: Experience with statistical analysis, sampling techniques and reporting methods preferred. Licensure/Certifications: Certification in professional medical coding, compliance, or audit Other Skills/Knowledge: The elements of an effective compliance program The essential OIG, DOJ and OCR materials The FCA, the Stark Law, the AKS, the CMP Law and the HIPAA Privacy Rule Other requirements/information: Proficient in applying statutory, regulatory and policy provisions to everyday clinical and business activities Excellent written and oral communication skills to explain often complicated requirements in a clear and concise way OSF HealthCare is an Equal Opportunity Employer.
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