Medicare RAC & Denials Appeals Manager

Prime Healthcare; Ontario (CA); On-site; CAD 100,000 - 132,000; Full time

Job summary

Prime Healthcare in California seeks a RAC Manager to lead data requests from government audits and manage the denial appeals process. You will coordinate with RAC, MAC, CERT, OIG, and related teams while maintaining audit tracking and reporting.

Responsibilities include supervising Medicare/Medicaid appeals, analyzing denials, and driving continuous improvement. Strong collaboration with case management, business office, and coding teams is essential.

Qualifications

• Master's degree in healthcare with one year of denial management experience.
• ECFMG Certification or US-based Bachelor's or higher in Health and Human Services preferred.
• Experience in nursing care, clinical outcomes; ability to collaborate with diverse groups and physicians.
• 1+ year of clinical experience in acute care setting preferred.
• Excellent written and verbal communication, critical thinking, and interpersonal skills.

Responsibilities

• Serve as primary contact for data/documentation requests from government audits (RAC, MAC, CERT, OIG, Probes).
• Manage the denial appeals process and coordinate with RAC team, Corporate Utilization Review and Clinical appeals team.
• Maintain integrity of tracking for government review audits and perform data analytics on denial trends.
• Lead process improvement and ensure timely reporting and follow-up of denials.

Skills

Communication skills

Critical thinking

Interpersonal skills

Independent work

Education

Master's in healthcare

ECFMG Certification or US Bachelor's in Health and Human Services

Job description

Prime Healthcare in California seeks a RAC Manager to lead data requests from government audits and manage the denial appeals process. You will coordinate with RAC, MAC, CERT, OIG, and related teams while maintaining audit tracking and reporting.

Responsibilities include supervising Medicare/Medicaid appeals, analyzing denials, and driving continuous improvement. Strong collaboration with case management, business office, and coding teams is essential.