RAC Compliance & Denials Manager

Prime Healthcare; New York, Northern (NY, KY); Hybrid; USD 72,000 - 95,000; Full time

Benefits offered by this job

Total rewards package

401K retirement plan

Medical, dental, and vision coverage

Tuition reimbursement

Job summary

Prime Healthcare, a major health system, seeks a RAC Manager to handle data/documentation requests from government audits and manage the appeals process. You will serve as SME for the appeals process and coordinate with RAC team, Corporate Utilization Review and Clinical appeals team.

Responsibilities include supervising Medicare and Medicaid Appeals, analyzing denial trends, and implementing improvements. Strong communication and interpersonal skills are essential in a collaborative healthcare

Qualifications

• Master’s in healthcare with one year experience in denial management.
• Excellent written and verbal communication skills.
• Excellent critical thinking skills.
• Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.

Responsibilities

• Handle data/documentation requests from Government audits and manage the appeals process.
• Serve as SME for the appeals process and coordinate with RAC team and Corporate Utilization Review.
• Supervise Medicare and Medicaid Appeals process and monitor denial trends.
• Perform audits and develop process improvements for identified deficiencies.

Skills

Communication skills

Critical thinking

Interpersonal skills

Education

Master’s in healthcare

ECFMG Certification

Bachelor’s in Health and Human Services

Job description

Prime Healthcare, a major health system, seeks a RAC Manager to handle data/documentation requests from government audits and manage the appeals process. You will serve as SME for the appeals process and coordinate with RAC team, Corporate Utilization Review and Clinical appeals team.

Responsibilities include supervising Medicare and Medicaid Appeals, analyzing denial trends, and implementing improvements. Strong communication and interpersonal skills are essential in a collaborative healthcare