Job Description

The Patient Accounting, Recovery Audit Contractor (RAC) Financial Analyst reflects the mission, vision, and values of Northwestern Memorial, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Under the direction of the Patient Accounting (“PA”) Medicare & Medicaid Manager, the RAC Financial Analyst will serve as the primary department resource in support of all activities related to the Medicare and Medicaid Recovery Audit Contractor (“RAC”) programs. This includes generating financial and other relevant information for RAC claims under review, documenting RAC activity in appropriate systems, and adjusting DRG/claim information as necessary related to RAC activities.

Responsibilities:

Monitor RAC program updates, as they relate to Patient Accounting and Patient Financial Service functions (i.e., Admitting & Registration and Patient Accounting). 

In conjunction with the Office of Corporate Compliance & Integrity and other areas, assist in the coordination of and perform various RAC related activities that are the responsibility of the PA department to ensure RAC documentation requests and deadlines are met.

Monitors RAC related publications and resources to assist Patient Accounting management with understanding RAC related issues, as it relates to PA functions.

Monitors and communicates potential RAC issues impacting Patient Accounting and compiles action/activity reports in support of corrective action/process improvement.

Generates financial and other relevant information for RAC claims under review and researches and facilitates data gathering for Manager of Patient Accounting, Director of Patient Accounting and/or the Office of Corporate Compliance & Integrity providing data and/or various reports.

Inputs RAC notation, DRG, claim, and reimbursement information related to RAC claims under review into appropriate systems (i.e., Primes, RACTracker, etc.)  Collects, organizes, and interprets RAC data for identification and prioritization of areas of risk.

Works with Office of Corporate Compliance & Integrity, Billing and other hospital areas to implement operational changes to ensure NM compliance with RAC requirements as they relate to PA functions.

Works with the NM Academy and PFS Management to ensure timely, accurate, and regular Compliance Education and Training programs within PFS.

Adjusts claim information in applicable systems to appropriately reflect accurate DRG, level of care, etc. for RAC claims under review.

Assess/evaluate new RAC information and help determine required systems or operational actions.

Document completely, issues and resolutions, on a case by case basis, providing a comprehensive audit trail.

Consistently practice “Patients First” philosophy and adhere to high standard of customer service consistently for internal and external customers.

Evaluate procedures and suggest improvements and changes to enhance customer service and operational efficiency.

Performs other related duties as assigned by manager.