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Job Title:

RAC Specialist

Cost Center:

Revenue Integrity

Job Description:

Position Summary:

The RAC Specialist serves as the organizational subject matter specialist for Recovery Audit Contractor and related government claim recovery activities. This position independently interprets CMS and payer requirements, evaluates audit risk, manages audit responses and appeals, and provides financial data analysis to support internal and external reporting. The role is accountable for maintaining audit readiness, developing appeal strategies, identifying reimbursement and compliance trends, and providing consultative guidance to interdisciplinary partners to reduce avoidable denials and support accurate, compliant reimbursement.

Minimum Qualification:

• Education

Associate degree in health information management, healthcare administration, business, finance, nursing, or related field preferred. Equivalent combination of education and directly related healthcare revenue cycle, billing, coding, audit, denial management, or reimbursement experience may be considered. Requires demonstrated knowledge of CMS regulations, Medicare and Medicaid billing requirements, payer audit processes, healthcare documentation standards, and state and federal laws related to healthcare reimbursement and compliance.

• Credentials

Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or comparable revenue cycle, coding, or health information credential preferred. Active pursuit of an applicable certification may be considered with relevant experience. Clinical background, audit and appeals experience, and demonstrated ability to interpret complex payer requirements, analyze reimbursement data, communicate findings, and independently manage deadlines are preferred.

Essential Functions:

• Serves as the organizational subject matter specialist for government claim recovery activities, including RAC, Medicare, Medicaid, and related audit programs.
• Independently evaluates, prioritizes, and manages audit requests and demand letters to ensure complete, accurate, and timely responses.
• Assesses audit determinations, develops appeal strategies, prepares supporting documentation, and monitors appeal deadlines through resolution.
• Performs advanced research and analysis of Medicare and Medicaid billing, coding, documentation, and reimbursement data to identify audit exposure, summarize findings, and recommend corrective action.
• Provides consultative guidance to facility subject matter experts and interdisciplinary partners regarding audit findings, documentation requirements, and regulatory expectations.
• Develops, maintains, and analyzes audit tracking tools and databases to identify trends in billing practices, denial patterns, reimbursement risk, and opportunities for prevention.
• Manages internal and external audit-related communications, ensuring appropriate escalation, professional correspondence, and consistent documentation of outcomes.
• Leads ongoing process evaluation and improvement efforts to strengthen audit readiness, reduce avoidable denials, and support compliance with payer and regulatory requirements.
• Partners with interdisciplinary teams to identify high-risk audit and reimbursement issues, prioritize improvement opportunities, and implement tools or workflows that mitigate organizational risk.

Join us. Join great. Join the dynamic team at Great Plains Health and be a part of something truly exceptional. At Great Plains Health, we embody a culture defined by authenticity, integrity, and a genuine commitment to listening to both our patients and each other.

As a member of our team, you'll experience a supportive environment where collaboration is key, and every voice is valued. We work together seamlessly, leveraging our collective strengths to provide the highest quality care to our community.

Passion drives us forward, propelling us to constantly strive for excellence in everything we do. If you're seeking a rewarding career in healthcare surrounded by like-minded individuals who share your dedication and enthusiasm, Great Plains Health is the place for you. Come join us and be part of a team that's making a real difference every day.