RECOVERY AUDIT COORDINATOR

The Recovery Audit Coordinator is responsible for managing the recovery audit process to identify and address reimbursement discrepancies, mitigate financial risks, and ensure compliance with payer policies and regulations. This role involves coordinating recovery audits, analyzing claims data, and collaborating with internal and external stakeholders to optimize revenue recovery efforts.

Essential Job Duties

Audit Management

• Oversee all aspects of the recovery audit process, including payer requests, internal reviews, and appeals.
• Act as the primary liaison with payers and recovery audit contractors (RACs) during the audit process.

Claims Analysis

• Analyze claims data to identify trends in denials, recoupments, and audit discrepancies.
• Investigate root causes of audit findings and recommend corrective actions to prevent future discrepancies.

Compliance and Documentation

• Ensure all audits and appeals comply with federal, state, and payer-specific regulations.
• Maintain accurate records of audit findings, correspondence, and outcomes.

Appeals and Resolutions

• Prepare and submit appeals for denied or recouped claims in a timely manner.
• Collaborate with internal departments to gather necessary documentation and evidence to support appeals.

Reporting and Communication

• Develop and present regular reports on audit trends, outcomes, and financial impacts to leadership.
• Communicate audit findings and improvement strategies to relevant stakeholders.

Nonessential Tasks

• Assist with the development and refinement of revenue cycle policies and procedures.
• Participate in department meetings and contribute to revenue integrity improvement initiatives.
• Perform other accounts functions as needed to support the overall financial operations of the organization.

Required Experience

• Minimum of 3 years of experience in revenue cycle management, healthcare compliance, or auditing.
• Knowledge of medical billing codes (CPT, ICD-10) and payer reimbursement processes.

Preferred Experience

• Exceptional analytical skills with the ability to interpret and present complex financial data.
• Proficiency in revenue cycle systems and Microsoft Office applications.
• Strong problem-solving and negotiation skills to resolve audit-related issues effectively.
• Excellent written and verbal communication skills to manage relationships with payers and contractors.

Required Licensure/Education

• Associates degree in Healthcare Administration, Business, Finance, or a related field is required.

Preferred Licensure/Education

• Bachelors degree is preferred.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more so your journey at and away from work is remarkable. Our Total Rewards package includes: 

Compensation

•              Base compensation within the positions pay range based on factors such as qualifications, skills, relevant experience, and/or training
•              Premium pay such as shift differential, on-call
•              Opportunity for annual increases based on performance

Benefits - .5 to 1.0 FTE

•              Paid Time Off programs
•              Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
•              Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
•              Defined contribution retirement plans with employer match and other financial wellness programs
•              Educational Assistance Program

Benefits - .001 to .49 FTE:

•              Paid Leave Hours accrued as you work

Exposure/Sensory Requirements

Exposure to:

• Chemicals: Refer to MSDS Sheets
• Video Display Terminals: Extreme
• Blood and Body Fluids: None
• TB or Airborne Pathogens: None

Sensory requirements (speech, vision, smell, hearing, touch):

• Speech: Needed for presentations/training, telephone communication, facilitate meetings.
• Vision: Needed to read memos and literature
• Smell: Helpful to note presence of electrical/fire hazard.
• Hearing: Needed for telephone communication, meetings, alarms and listening to employee concerns.
• Touch: Needed to write, computer entry, filing.

Activity/Lifting Requirement

Percentage of time during the normal workday the employee is required to:

• Sit: 90%
• Twist: 5%
• Stand: 0%
• Crawl: 0%
• Walk: 0%
• Kneel: 0%
• Lift: 0%
• Drive: 1%
• Squat: 0%
• Climb: 0%
• Bend: 0%
• Reach above shoulders: 0%

The weight required to be lifted each normal workday according to the continuum described below:

• Up to 10 lbs: Occasionally
• Up to 20 lbs: Occasionally
• Up to 35 lbs: Not Required
• Up to 50 lbs: Not Required
• Up to 75 lbs: Not Required
• Up to 100 lbs: Not Required
• Over 100 lbs: Not Required

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):

Lift reports to and from storage files and cabinets.

Maximum consecutive time (minutes) during the normal workday for each activity:

• Sit: 120
• Twist: 5
• Stand: 0
• Crawl: 0
• Walk: 0
• Kneel: 0
• Lift: 0
• Drive: 0
• Squat: 0
• Climb: 0
• Bend: 0
• Reach above shoulders: 0

Repetitive use of hands (Frequency indicated):

• Simple grasp up to 10 lbs. 
• Normal weight: 5-10lbs
• Pushing & pulling Normal weight: Up to 20lbs
• Fine Manipulation: Calculator, keyboard.
• Repetitive use of foot or feet in operating machine control: None

Environmental Factors & Special Hazards

• Environmental Factors (Time Spent):
• Inside hours: 8
• Outside hours : 0
• Temperature: Normal Range
• Lighting: Average
• Noise levels: Average
• Humidity: Dry
• Atmosphere: Dust, poor ventilation

Special Hazards: None

Protective Clothing Required: None